Instructions for Classifying the Multiple Causes of Death, ICD-10, 2025

ICD-10-Mortality Manual 2b - 2025

Instruction Manual

Part 2b

Instructions for Classifying the Multiple Causes of Death, 2025

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

National Center for Health Statistics

SECTION I - INSTRUCTIONS FOR CLASSIFYING MULTIPLE CAUSES OF DEATH, 2025

SECTION I - INTRODUCTION

A. Introduction

This manual provides instructions to mortality medical coders and nosologists for coding multiple causes of death from death certificates filed in the states. These mortality coding instructions are used by both the State vital statistics programs and the National Center for Health Statistics (NCHS), which is the Federal agency responsible for the compilation of U.S. statistics on causes of death. NCHS is part of the Centers for Disease Control and Prevention.

In coding causes of death, NCHS adheres to the World Health Organization Nomenclature Regulations specified in the most recent revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). NCHS also uses the ICD international rules for selecting the underlying cause of death for primary mortality tabulation in accordance with the international rules.

Beginning with deaths occurring in 1999, the Tenth Revision of the ICD (ICD-10) is being used for coding and classifying causes of death. This revision of the Classification is published by the World Health Organization (WHO) and consists of three volumes.

Volume 1 contains a list of three-character categories, the tabular list of inclusions, and the four-character subcategories. The supplementary Z code appears in Volume 1 but is not used for classifying mortality data. Optional fifth characters are provided for certain categories and an optional independent four-character coding system is provided to classify histological varieties of neoplasm, prefixed by the letter M (for morphology) and followed by a fifth character indicating behavior. These optional codes, except those for place of occurrence of external cause and activity code related to external cause codes, are not used in NCHS. The place code and activity code are used as supplementary codes rather than as additional characters. Volume 2 includes the international rules and notes for use in classifying and tabulating underlying cause-of-death data. Volume 3 is an alphabetical index containing a comprehensive list of terms for use in coding. Copies of these volumes may be purchased in hard-copy or on diskette from the following address:

WHO Publications Center
49 Sheridan Avenue
Albany, New York 12210
Tel. 518-436-9686

NCHS has prepared an updated version of Volume 1 and Volume 3 to be used for both underlying and multiple cause-of-death coding. The major purpose of the updated version is to provide a single published source of code assignments including terms not indexed in Volume 3 of ICD-10. NCHS has included all nonindexed terms encountered in the coding of deaths during 1979-1994, under the Ninth Revision of the International Classification of Diseases (ICD-9). With the availability of the updated Volumes 1 and 3, NCHS will discontinue publishing the Part 2e manual, Nonindexed Terms, Standard Abbreviations, and State Geographic Codes Used in Mortality Data Classification, which was first published in 1983. Due to copyright considerations, the updated Volumes 1 and 3 may not be reproduced for distribution outside of NCHS and State vital statistics agencies.

The basic purpose of this manual is to document concepts and instructions for coding multiple causes of death, which were developed by NCHS for use with the Eighth Revision of the ICD adapted for use in the United States (ICDA-8), and which were updated to ICD-9, and subsequently to ICD-10. The coding concepts are generally consistent with provisions of ICD-10. Thus, this manual should be used with ICD-10, Volumes 1 and 3 as updated by NCHS. The list of abbreviations used in medical terminology (Appendix A), the list of synonymous sites (Appendix B), and the list of geographic codes (Appendix C) are included in this publication.

NCHS does not use the “dagger and asterisk” system which WHO introduced in ICD-9 and continued in ICD-10. For some medical conditions, this system provides two codes, which distinguish between the etiology or underlying disease process and the manifestation or complication for selected conditions. The etiology or underlying disease codes is denoted with a dagger (†) and the manifestation or complication code by an asterisk (*) following the code. For example, Coxsackie myocarditis has a code (B33.2†) marked with a dagger in the chapter for infectious and parasitic diseases and a different code (I41.1*) marked with an asterisk in the chapter for diseases of the circulatory system. Similarly, diabetic nephropathy has a dagger code (E14.2 †) in the chapter relating to endocrine disease and an asterisk code (N08.3*) in the genitourinary system chapter. Under ICD-9, limited use was made of the asterisk codes in classifying mortality data for data years 1979-1982. Effective July 1982 the use of asterisk codes in mortality coding was discontinued and will not be used in the 10^th revision for mortality coding. NCHS assigns only the dagger code to such conditions.

The multiple cause-of-death codes are used as inputs to the ACME program (Automated Classification of Medical Entities) developed by NCHS to automatically select the underlying cause of death, and the TRANSAX program (Translation of Axes) used to produce multiple cause-of-death statistics, beginning with deaths occurring in 1968. As inputs, the computer programs require codes for each condition reported on the death certificate, usually in the order in which the information is recorded.

The outputs of the ACME program are the traditional underlying cause-of-death codes selected according to the selection and modification rules of the Classification, the same cause that would be selected using manual underlying cause-of-death coding instructions specified in Instruction Manual Part 2a. Thus, a single cause is associated with each decedent.

Using the same input codes, the TRANSAX program generates two sets of outputs: “entity-axis” codes that reflect the placement of each condition on the certificate for each decedent; and “record-axis” codes that, where appropriate, link two or more diagnostic conditions to form composite codes that are classifiable to a single code, according to the provisions of the Classification. Record axis codes are preferred for multiple cause tabulation to better convey the intent of the certifier, and to eliminate redundant cause-of-death information.

Major revisions from previous manuals

1. Corrections have been made to clarify instructions, spelling, and format throughout the manual. These changes are not specifically noted.

2. Section II, Part H, and Section II, Part O, 1, c, (4), updated terminology to reflect "current technical assistance protocol" instead of the outdated text.

3. Section II, Part N, 9, clarified that "99" means unknown duration when reported in the duration block.

4. Section IV, Part F, 11, c, added example to demo that 99 years in duration block does not represent sequela.

5. Section IV, Part G, 1 and 2, added SUPC (sudden unexpected postnatal collapse) to list of other SIDS abbreviations.

6. Section V, Part R, 2, d, added example to demo excessive codes when surgery and tobacco box reported.

7. Appendix A, added PAD and SUPC to the list.

8. Appendix A, clarified that "99" means unknown duration when reported in the duration block.

9. Appendix G, 5, added long COVID syndrome and past COVID syndrome to the U099 list.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Other manuals relating to coding causes of death are:

Part 2a, NCHS Instructions for Classifying the Underlying Cause of Death, 2025

Part 2c, ICD-10 ACME Decision Tables for Classifying the Underlying Causes of Death, 2025

Part 2k, Instructions for the Automated Classification of the Initiating and Multiple Causes of Fetal Death, 2025

Part 2s, SuperMICAR Data Entry Instruction, 2011

B. Medical Certification

The U. S. Standard Certificate of Death provides spaces for the certifying physician, coroner, or medical examiner to record pertinent information concerning the diseases, morbid conditions, and injuries which either resulted in or contributed to death as well as the circumstances of the accident or violence which produced any such injuries. The medical certification portion of the death certificate includes items 32-44. It is designed to obtain the opinion of the certifier as to the relationship and relative significance of the causes, which he reports.

A cause of death is the morbid condition or disease process, abnormality, injury, or poisoning leading directly or indirectly to death. The underlying cause of death is the disease or injury, which initiated the train of morbid events leading directly or indirectly to death or the circumstances of the accident or violence, which produced the fatal injury. A death often results from the combined effect of two or more conditions. These conditions may be completely unrelated, arising independently of each other or they may be causally related to each other; that is, one cause may lead to another which in turn leads to a third cause, etc.

The order in which the certifier is requested to arrange the causes of death upon the certification form facilitates the selection of the underlying cause when two or more causes are reported. He is requested to report in Part I on line (a) the immediate cause of death and the antecedent conditions on lines (b), (c), and (d) which gave rise to the cause reported on

I (a), the underlying cause being stated lowest in the sequence of events. However, no entry is necessary on I(b), I(c), or I(d) if the immediate cause of death, stated on I(a) describes completely the sequence of events. If the decedent had more than four causally related conditions relating to death, the certifier is requested to add lines (e), (f), etc., so all conditions related to the immediate cause of death are entered in Part I with only one condition to a line.

Any other significant condition which unfavorably influenced the course of the morbid process and thus contributed to the fatal outcome but not resulting in the underlying cause given in Part I is entered in Part II.

EXCERPT FROM U.S. STANDARD CERTIFICATE OF DEATH (Rev.11/2003)

Excerpt from U.S. Standard Certificate of Death

US STANDARD CERTIFICATE OF DEATH (Rev. 11/2003)

In the following example, there are three causes reported. On line I(c) the underlying cause is entered-congenital heart disease. Congenital heart disease gave rise to congestive heart failure (line I(b)) which in turn led to a myocardial infarction (line I(a)) -- the immediate cause of death.

I (a) Myocardial infarction

(b) Congestive heart failure

(d)

As demonstrated by the following example, the certifier may not always list one cause per line:

I (a) Myocardial infarction and pulmonary embolism with congestive heart failure

(b)

(c)

(d)

Likewise, the causes may not be reported in an acceptable sequence. In the following example, cancer is reported as due to diabetes.

I (a) Cancer

(b) Diabetes

(c)

(d)

To date, the causes of the majority of cancers are still unknown so the causal relationship tables stored in the NCHS computers preclude the assumption that diabetes caused the cancer. Cancer is selected as the underlying cause of death from this certification for statistical purposes. However, the selection of the underlying cause of death is not relevant for this manual. For coding purposes, the order and position of each cause of death reported on the death certificate must be interpreted accurately so the computer software can then determine the correct underlying cause of death.

There is an average of three causes listed per certificate. Approximately 20 percent have only one cause of death and 45 percent have three or more causes. Frequently, a cause will be reported on I(a) in Part I and a cause in Part II with no other reported causes. For other records, several causes may all be reported on a single line of the certificate or they may be entered on several lines in Part I. Rarely, the only cause(s) reported may be in Part II. Representative examples follow.

I (a) Pneumonia

(b)

(c)

(d)

II Diabetes

I (a) Cancer

(b)

(c)

(d)

I (a)

(b)

(c)

(d)

II Diabetes

I (a)

(b) Acute myocardial infarction

(c)

II Renal disease

I (a) AMI, renal disease, pulmonary embolism

SECTION II - GENERAL INSTRUCTIONS

A. Introduction

Code all information reported in the medical certification section of the death certificate and any other information pertaining to the medical certification, when reported elsewhere on the certificate. In Volumes 1 and 3 of ICD-10, the fourth-character subcategories of three-character categories are preceded by a decimal point. For coding purposes, omit the decimal point.

Enter codes in the same order and location as the entries they represent appear on the death certificate, proceeding from the entry reported uppermost in Part II downward and from the left to right. If the uppermost line in Part II is an obvious continuation of a line below, enter the codes accordingly.

For instructions on placement of codes when the certifier states or implies a “due to” relationship between conditions not reported in sequential order, refer to Section II, Part C, Format. For instructions on placement of nature of injury (N-code) and external cause codes (E-codes), refer to Section V, Part B, Placement of Nature of Injury and External Cause Codes.

When an identical code applies to more than one condition reported on the same line, enter the code for the first-mentioned of these conditions only. When conditions classifiable to the same code are reported on different lines of the certificate, enter the code for each of the reported conditions. (This does not apply to external cause of morbidity and mortality (E-codes)).

1. Excessive Codes

a. When a single line in Part I or Part II requires more than eight codes, delete the excessive codes (any over eight) for the line using the following criteria in the order listed:

(1) Delete ill-defined conditions (I461, I469, I959, I99, J960, J969, P285, R00-R94, R96, R98) except when this code is the first code on a line, proceeding right to left.

(2) Delete nature of injury codes (S000-T983) except for the first one entered on a line, proceeding right to left.

(3) If, after applying the preceding criteria, any single line still has more than eight codes, delete beginning with the last code on the line until only 8 remain.

I (a) I499

(b) I219 I739

(c)

(d)

II &E109 I739 T811 &Y835 R18 R33 N19 C475 N359 I490 I493 J181

After deleting excessive codes:

I (a) I499

(b) I219 I739

(c)

(d)

II &E109 I739 T811 &Y835 N19 C475 N359 I490

Delete (1) R33, (2) R18, (3) J181 and (4) I493

b. When a single record requires more than 14 codes, delete the excessive codes using the following criteria in the order listed:

(1) Delete ill-defined conditions (I461, I469, I959, I99, J960, J969, P285, R00 - R94, R96, R98) except when this code is the first code on a line, beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d, line c, line b, line a).

(2) Delete nature of injury codes (S000-T983) except for the first one entered on a line beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d, line c, line b, line a).

(3) Delete repetitive codes except when it is the first code on a line beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d, line c, line b, line a).

(4) If after applying the preceding criteria, any record still has more than 14 codes, delete beginning with the last code in Part II, proceeding upward right to left on each line (Part II, line e, line d, line c, line b, line a).

I (a) C80 I499 R570

(b) R098 R53

(d) I709 I635

II I119 C473 R200 I258 I251 D539 R798 I635

After deleting excessive codes:

I (a) C80 I499

(b) R098

(d) I709 I635

II I119 C473 I258 I251 D539 I635

Delete (1) R798, (2) R200, (3) R53 and (4) R570

2. Created Codes

To facilitate automated data processing, the following ICD-10 codes have been amended for use in coding and processing the multiple cause data. Special five character subcategories are for use in coding and processing the multiple cause data; however, they will not appear in official tabulations.

A169 Respiratory tuberculosis, unspecified

Excludes: Any term indexed to A169 not qualified as respiratory or pulmonary (A1690)

*A1690 Tuberculosis NOS

Includes: Any term indexed to A169 not qualified as respiratory or pulmonary

E039 Hypothyroidism, unspecified

Excludes: Any term indexed to E039 qualified as advanced, grave, severe, or with a similar qualifier (E0390)

*E0390 Advanced hypothyroidism

Grave hypothyroidism

Severe hypothyroidism

Includes: Any term indexed to E039 qualified as advanced, grave, severe, or with a similar qualifier

G122 Motor neuron disease

Excludes: Any term indexed to G122 qualified as advanced, grave, severe, or with a similar qualifier (G1220)

*G1220 Advanced motor neuron disease

Grave motor neuron disease

Severe motor neuron disease

Includes: Any term indexed to G122 qualified as advanced, grave, severe, or with a similar qualifier

G20 Parkinson disease

Excludes: Any term indexed to G20 qualified as advanced, grave, severe, or with a similar qualifier (G2000)

*G2000 Advanced Parkinson disease

Grave Parkinson disease

Severe Parkinson disease

Includes: Any term indexed to G20 qualified as advanced, grave, severe, or with a similar qualifier

I219 Acute myocardial infarction, unspecified

Excludes: Embolism of any site classified to I219

*I2190 Embolism cardiac, heart, myocardium or a synonymous site

Includes: Embolism of any site classified to I219

I420 Dilated cardiomyopathy

Excludes: Any term indexed to I420 qualified as familial, idiopathic, or primary (I4200)

*I4200 Familial dilated cardiomyopathy

Idiopathic dilated cardiomyopathy

Primary dilated cardiomyopathy

Includes: Any term indexed to I420 qualified as familial, idiopathic, or primary

I421 Obstructive hypertrophic cardiomyopathy

Excludes: Any term indexed to I421 qualified as familial, idiopathic, or primary (I4210)

*I4210 Familial obstructive hypertrophic cardiomyopathy

Idiopathic obstructive hypertrophic cardiomyopathy

Primary obstructive hypertrophic cardiomyopathy

Includes: Any term indexed to I421 qualified as familial, idiopathic, or primary

I422 Other hypertrophic cardiomyopathy

Excludes: Any term indexed to I422 qualified as familial, idiopathic, or primary (I4220)

*I4220 Familial other hypertrophic cardiomyopathy

Idiopathic other hypertrophic cardiomyopathy

Primary other hypertrophic cardiomyopathy

Includes: Any term indexed to I422 qualified as familial, idiopathic, or primary

I425 Other restrictive cardiomyopathy

Excludes: Any term indexed to I425 qualified as familial, idiopathic, or primary (I4250)

*I4250 Familial other restrictive cardiomyopathy

Idiopathic other restrictive cardiomyopathy

Primary other restrictive cardiomyopathy

Includes: Any term indexed to I425 qualified as familial, idiopathic, or primary

I428 Other cardiomyopathies

Excludes: Any term indexed to I428 qualified as familial, idiopathic, or primary (I4280)

*I4280 Familial other cardiomyopathies

Idiopathic other cardiomyopathies

Primary other cardiomyopathies

Includes: Any term indexed to I428 qualified as familial, idiopathic, or primary

I429 Cardiomyopathy, unspecified

Excludes: Any term indexed to I429 qualified as familial, idiopathic, or primary (I4290)

*I4290 Familial cardiomyopathy

Idiopathic cardiomyopathy

Primary cardiomyopathy

Includes: Any term indexed to I429 qualified as familial, idiopathic, or primary

I500 Congestive heart failure

Excludes: Any term indexed to I500 qualified as advanced, grave, severe, or with a similar qualifier (I5000)

*I5000 Advanced congestive heart failure

Grave congestive heart failure

Severe congestive heart failure

Includes: Any term indexed to I500 qualified as advanced, grave, severe, or with a similar qualifier

I514 Myocarditis, unspecified

Excludes: Any term indexed to I514

qualified as arteriosclerotic (I5140)

*I5140 Arteriosclerotic myocarditis

Includes: Any term indexed to I514 qualified as arteriosclerotic

I515 Myocardial degeneration

Excludes: Any term indexed to I515

qualified as arteriosclerotic (I5150)

*I5150 Arteriosclerotic myocardial degeneration

Includes: Any term indexed to I515 qualified as arteriosclerotic

I600 Subarachnoid hemorrhage from carotid siphon and bifurcation

Excludes: Ruptured carotid aneurysm (into brain) (I6000)

*I6000 Ruptured carotid aneurysm (into brain)

I606 Subarachnoid hemorrhage from other intracranial arteries

Excludes: Ruptured aneurysm (congenital) circle of Willis (I6060)

*I6060 Ruptured aneurysm (congenital) circle of Willis

I607 Subarachnoid hemorrhage from intracranial artery, unspecified

Excludes: Ruptured berry aneurysm (congenital) brain (I6070)

Ruptured miliary aneurysm (I6070)

*I6070 Ruptured berry aneurysm (congenital) brain

Ruptured miliary aneurysm

I608 Other subarachnoid hemorrhage

Excludes: Ruptured aneurysm brain meninges (I6080)

Ruptured arteriovenous aneurysm (congenital) brain (I6080)

Ruptured (congenital) arteriovenous aneurysm cavernous sinus (I6080)

*I6080 Ruptured aneurysm brain meninges

Ruptured arteriovenous aneurysm (congenital) brain

Ruptured (congenital) arteriovenous aneurysm cavernous sinus

I609 Subarachnoid hemorrhage, unspecified

Excludes: Ruptured arteriosclerotic cerebral aneurysm (I6090)

Ruptured (congenital) cerebral aneurysm NOS (I6090)

Ruptured mycotic aneurysm brain (I6090)

*I6090 Ruptured arteriosclerotic cerebral aneurysm

Ruptured (congenital) cerebral aneurysm NOS

Ruptured mycotic aneurysm brain

I610 Intracerebral hemorrhage in hemisphere, subcortical

Excludes: Any term indexed to I610 qualified as bilateral, multiple, or ^[i]similar term (I6100)

*I6100 Bilateral, multiple [or ^[i]similar term] intracerebral hemorrhages in hemisphere, subcortical

Includes: Any term indexed to I610 qualified as bilateral, multiple, or ^[i]similar term

I611 Intracerebral hemorrhage in hemisphere, cortical

Excludes: Any term indexed to I611 qualified as bilateral, multiple, or ^[i]similar term (I6110)

*I6110 Bilateral, multiple [or ^[i]similar term] intracerebral hemorrhages in hemisphere, cortical

Includes: Any term indexed to I611 qualified as bilateral, multiple, or ^[i]similar term

I612 Intracerebral hemorrhage in hemisphere, unspecified

Excludes: Any term indexed to I612 qualified as bilateral, multiple, or ^[i]similar term (I6120)

*I6120 Bilateral, multiple [or ^[i]similar term] intracerebral hemorrhages, unspecified

Includes: Any term indexed to I612 qualified as bilateral, multiple, or ^[i]similar term

I613 Intracerebral hemorrhage in brain stem

Excludes: Any term indexed to I613 qualified as bilateral, multiple, or ^[i]similar term (I6130)

*I6130 Bilateral, multiple [or ^[i]similar term] intracerebral hemorrhages in brain stem

Includes: Any term indexed to I613 qualified as bilateral, multiple, or ^[i]similar term

I614 Intracerebral hemorrhage in cerebellum

Excludes: Any term indexed to I614 qualified as bilateral, multiple, or ^[i]similar term (I6140)

*I6140 Bilateral, multiple [or ^[i]similar term] intracerebral hemorrhages in cerebellum

Includes: Any term indexed to I614 qualified as bilateral, multiple, or ^[i]similar term

I615 Intracerebral hemorrhage, intraventricular

Excludes: Any term indexed to I615 qualified as bilateral, multiple, or ^[i]similar term (I6150)

*I6150 Bilateral, multiple [or ^[i]similar term] intracerebral hemorrhages, intraventricular

Includes: Any term indexed to I615 qualified as bilateral, multiple, or ^[i]similar term

I618 Other intracerebral hemorrhage

Excludes: Any term indexed to I618 qualified as bilateral, multiple, or ^[i]similar term (I6180)

*I6180 Bilateral, multiple [or ^[i]similar term] other intracerebral hemorrhages

Includes: Any term indexed to I618 qualified as bilateral, multiple, or ^[i]similar term

I619 Intracerebral hemorrhage, unspecified

Excludes: Any term indexed to I619 qualified as bilateral, multiple, or ^[i]similar term (I6190)

*I6190 Bilateral, multiple [or ^[i]similar term] intracerebral hemorrhages, unspecified

Includes: Any term indexed to I619 qualified bilateral, multiple, or ^[i]similar term

I630 Cerebral infarction due to thrombosis of precerebral arteries

Excludes: Any term indexed to I630 qualified as bilateral, multiple, or ^[i]similar term (I6300)

*I6300 Cerebral infarction due to bilateral, multiple [or ^[i]similar term] thrombi of precerebral arteries

Includes: Any term indexed to I630 qualified as bilateral, multiple, or ^[i]similar term

I631 Cerebral infarction due to embolism of precerebral arteries

Excludes: Any term indexed to I631 qualified as bilateral, multiple, or ^[i]similar term (I6310)

*I6310 Cerebral infarction due to bilateral, multiple [or ^[i]similar term] emboli of precerebral arteries

Includes: Any term indexed to I631 qualified as bilateral, multiple, or ^[i]similar term

I632 Cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries

Excludes: Any term indexed to I632 qualified as bilateral, multiple, or ^[i]similar term (I6320)

*I6320 Cerebral infarction due to bilateral, multiple [or ^[i]similar term]unspecified occlusions or stenosis of precerebral arteries

Includes: Any term indexed to I632 qualified as bilateral, multiple, or ^[i]similar term

I633 Cerebral infarction due to thrombosis of cerebral arteries

Excludes: Any term indexed to I633 qualified as bilateral, multiple, or ^[i]similar term (I6330)

*I6330 Cerebral infarction due to bilateral, multiple [or ^[i]similar term] thrombi of cerebral arteries

Includes: Any term indexed to I633 qualified as bilateral, multiple, or ^[i]similar term

I634 Cerebral infarction due to embolism of cerebral arteries

Excludes: Any term indexed to I634 qualified as bilateral, multiple, or ^[i]similar term (I6340)

*I6340 Cerebral infarction due to bilateral, multiple [or ^[i]similar term] emboli of cerebral arteries

Includes: Any term indexed to I634 qualified as bilateral, multiple, or ^[i]similar term

I635 Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries

Excludes: Any term indexed to I635 qualified as bilateral, multiple, or ^[i]similar term(I6350)

*I6350 Cerebral infarction due to bilateral, multiple [or ^[i]similar term]unspecified occlusions or stenosis of cerebral arteries

Includes: Any term indexed to I635 qualified as bilateral, multiple, or ^[i]similar term

I636 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic

Excludes: Any term indexed to I636 qualified as bilateral, multiple, or ^[i]similar term (I6360)

*I6360 Cerebral infarction due to bilateral, multiple [or ^[i]similar term]

cerebral venous thrombi, nonpyogenic

Includes: Any term indexed to I636 qualified as bilateral, multiple, or ^[i]similar term

I638 Other cerebral infarction

Excludes: Any term indexed to I638 qualified as bilateral, multiple, or ^[i]similar term (I6380)

*I6380 Bilateral, multiple [or ^[i]similar term] other cerebral infarctions

Includes: Any term indexed to I638 qualified bilateral, multiple, or ^[i]similar term

I639 Cerebral infarction, unspecified

Excludes: Any term indexed to I639 qualified as bilateral, multiple, or ^[i]similar term (I6390)

*I6390 Bilateral, multiple [or ^[i]similar term] cerebral infarctions, unspecified

Includes: Any term indexed to I639 qualified as bilateral, multiple, or ^[i]similar term

I64 Stroke, not specified as hemorrhage or infarction

Excludes: Any term indexed to I64 qualified as bilateral, multiple, or ^[i]similar term(I6400)

*I6400 Bilateral, multiple [or ^[i]similar term] strokes, not specified as hemorrhage or infarction

Includes: Any term indexed to I64 qualified as bilateral, multiple, or ^[i]similar term

I691 Sequelae of intracerebral hemorrhage

Excludes: Any term indexed to I691 qualified as bilateral, multiple, or ^[i]similar term (I6910)

*I6910 Sequela of bilateral, multiple [or ^[i]similar term] intracerebral hemorrhages

Includes: Any term indexed to I691 qualified as bilateral, multiple, or ^[i]similar term

I693 Sequelae of cerebral infarction

Excludes: Any term indexed to I693 qualified as bilateral, multiple, or ^[i]similar term (I6930)

*I6930 Sequela of bilateral, multiple [or ^[i]similar term] cerebral infarctions

Includes: Any term indexed to I693 qualified as bilateral, multiple, or ^[i]similar term

I694 Sequelae of stroke, not specified as hemorrhage or infarction

Excludes: Any term indexed to I694 qualified as bilateral, multiple, or ^[i]similar term (I6940)

*I6940 Sequela of bilateral, multiple [or ^[i]similar term] strokes, not specified as hemorrhage or infarction

Includes: Any term indexed to I694 qualified as bilateral, multiple, or ^[i]similar term

J101 Influenza with other respiratory manifestations, influenza virus identified

Excludes: Influenza, flu, grippe (viral), influenza virus identified (without specified manifestations) (J1010)

*J1010 Influenza, flu, grippe (viral), influenza virus identified (without specified manifestations)

J111 Influenza with other respiratory manifestations, virus not identified

Excludes: Influenza, flu, grippe (viral), influenza virus not identified (without specified manifestations) (J1110)

*J1110 Influenza, flu, grippe (viral), influenza virus not identified (without specified manifestations)

J849 Interstitial pulmonary disease, unspecified

Excludes: Interstitial pneumonia, not elsewhere classified (J8490)

*J8490 Interstitial pneumonia, not elsewhere classified

J984 Other disorders of lung

Excludes: Lung disease (acute) (chronic) NOS (J9840)

*J9840 Lung disease (acute) (chronic) NOS

K319 Disease of stomach and duodenum, unspecified

Excludes: Disease, stomach NOS (K3190)

Lesion, stomach NOS (K3190)

*K3190 Disease, stomach NOS

Lesion, stomach NOS

K550 Acute vascular disorders of intestine

Excludes: Any term indexed to K550 qualified as embolic (K5500)

*K5500 Acute embolic vascular disorders of intestine

Includes: Any term indexed to K550 qualified as embolic

K631 Perforation of intestine (nontraumatic)

Excludes: Intestinal penetration, unspecified part (K6310)

Intestinal perforation, unspecified part (K6310)

Intestinal rupture, unspecified part (K6310)

*K6310 Intestinal penetration, unspecified part

Intestinal perforation, unspecified part

Intestinal rupture, unspecified part

K720 Acute and subacute hepatic failure

Excludes: Acute hepatic failure (K7200)

*K7200 Acute hepatic failure

K721 Chronic hepatic failure

Excludes: Chronic hepatic failure (K7210)

*K7210 Chronic hepatic failure

K729 Hepatic failure, unspecified

Excludes: Hepatic failure (K7290)

*K7290 Hepatic failure

M199 Arthrosis, unspecified

Excludes: Any term indexed to M199 qualified as advanced, grave, severe, or with a similar qualifier (M1990)

*M1990 Advanced arthrosis

Grave arthrosis

Severe arthrosis

Includes: Any term indexed to M199 qualified as advanced, grave, severe, or with a similar qualifier

Q278 Other specified congenital malformations of peripheral vascular system

Excludes: Congenital aneurysm (peripheral) (Q2780)

*Q2780 Congenital aneurysm (peripheral)

Q282 Arteriovenous malformation of cerebral vessels

Excludes: Congenital arteriovenous cerebral aneurysm (nonruptured) (Q2820)

*Q2820 Congenital arteriovenous cerebral aneurysm (nonruptured)

Q283 Other malformations of cerebral vessels

Excludes: Congenital cerebral aneurysm (nonruptured) (Q2830)

*Q2830 Congenital cerebral aneurysm (nonruptured)

R58 Hemorrhage, not elsewhere classified

Excludes: Hemorrhage of unspecified site (R5800)

*R5800 Hemorrhage of unspecified site

R99 Other ill-defined and unspecified causes of mortality

Excludes: Cause unknown (R97)

*R97 Cause unknown

3.“Dagger and asterisk” codes

ICD-10 provides for the classification of certain diagnostic statements according to two different axes-etiology or underlying disease process and manifestation or complication. Thus, there are two codes for diagnostic statements subject to dual classification. The etiology or underlying disease codes are marked with a dagger (†) and the manifestations or complication codes are marked with an asterisk (*) following the code. The terms classified to codes with an asterisk are to be coded to the dagger code for the term only. These codes will not appear in official tabulations on multiple cause data.

I (a) Salmonella meningitis A022

Use only the dagger code for multiple cause-of-death coding.

Do not use the following ICD-10 codes for multiple cause coding:

D63* H03* I68* M36*

D77* H06* I79* M49*

E35* H13* I98* M63*

E90* H19* J17* M68*

F00* H22* J91* M73*

F02* H28* J99* M82*

G01* H32* K23* M90*

G02* H36* K67* N08*

G05* H42* K77* N16*

G07* H45* K87* N22*

G13* H48* K93* N29*

G22* H58* L14* N33*

G26* H62* L45* N37*

G32* H67* L54* N51*

G46* H75* L62* N74*

G53* H82* L86* P75*

G55* H94* L99*

G59* I32* M01*

G63* I39* M03*

G73* I41* M07*

G94* I43* M09*

G99* I52* M14*

B. General coding concept

The coding of cause-of-death information for the ACME system consists of the assignment of the most appropriate ICD-10 code(s) for each diagnostic entity that is reported on the death certificate. In order to arrive at the appropriate code for a diagnostic entity, code each entity separately. Do not apply provisions in ICD-10 for linking two or more diagnostic terms to form a composite diagnosis classifiable to a single ICD-10 code.

I (a) Cholecystitis with cholelithiasis K819 K802

Code each entity separately even though the Index has provided for a combination code for cholecystitis with cholelithiasis.

I (a) Malignant neoplasm of colon with rectum C189 C20

Code malignant neoplasm of colon and malignant neoplasm of rectum separately even though the Index has provided for a combination code for malignant neoplasm of colon with rectum.

Place I (a) Injury of intra-abdominal and intrathoracic organs S369 S279

9 II &X599

Code injury of each site separately even though the Index has provided for a combination code for intra-abdominal and intrathoracic injury.

1. Definitions and types of diagnostic entities

A diagnostic entity is a single term or a composite term, comprised of one word or of two or more adjoining words, that is used to describe a disease, nature of injury, or other morbid condition. In this manual diagnostic entity and diagnostic term are used interchangeably. A diagnostic entity may indicate the existence of a condition classifiable to a single ICD-10 category or it may contain elements of information that are classifiable to different ICD-10 categories. For coding purposes, it is necessary to distinguish between two different kinds of diagnostic entities - a “one-term entity,” and a “multiple one-term entity.”

a. One-term entity

(1) A one-term entity is a diagnostic entity that is classifiable to a single ICD-10.

I (a) Pneumonia J189

(b) Arteriosclerosis I709

These terms are codable one-term entities.

I (a) Allergic vasculitis D690

This condition is indexed as one-term entity under “vasculitis.”

I (a) Cerebral arteriosclerosis I672

This condition is indexed as one-term entity.

(2) A diagnostic term that contains one of the following adjectival modifiers indicates the condition modified has undergone certain changes and is considered to be a one-term entity.

adenomatous hypoxemic

anoxic hypoxic

congestive inflammatory

cystic ischemic

embolic necrotic, necrotizing

erosive obstructed, obstructive

gangrenous ruptured

hemorrhagic

(These instructions apply to these adjectival modifiers only).

For code assignment, apply the following criteria in the order stated.

(a) If the modifier and lead term are indexed together, code as indexed.

I (a) Embolic nephritis N058

Code Nephritis, embolic. The adjectival modifier “embolic” is indexed under nephritis.

(b) If the modifier is not indexed under the lead term, but “specified” is, use the code for specified (usually .8).

I (a) Obstructive cystitis N308

Code Cystitis, specified NEC. The adjectival modifier “obstructive” is not indexed under cystitis.

(c) If neither the modifier nor “specified” is indexed under the lead term, refer to Volume 1 under the NOS code for the lead term and look for a specified 4^th character subcategory.

I (a) Hemorrhagic cardiomyopathy I428

Code hemorrhagic cardiomyopathy to I428, Other cardiomyopathies. “Hemorrhagic” is not indexed under cardiomyopathy, neither is Cardiomyopathy, specified NEC indexed. The Classification does provide a code, I428, for “Other cardiomyopathies” in Volume 1.

(d) If neither (a), (b), or (c) apply, code the lead term without the modifier.

I (a) Adenomatous bronchiectasis J47

“Adenomatous” is not an index term qualifying bronchiectasis. Code bronchiectasis only, since there is no provision in the Classification for coding “other bronchiectasis.”

b. Multiple one-term entity

A multiple one-term entity is a diagnostic entity consisting of two or more contiguous words on a line for which the Classification does not provide a single code for the entire entity but does provide a single code for each of the components of the diagnostic entity. Consider as a multiple one-term entity if each of the components can be considered as separate one-term entities, i.e., they can stand alone as separate diagnosis. Code each component of the multiple one-term entity as indexed and on the same line where reported.

I (a) Myocardial infarction I219

(b) Uremic acidosis N19 E872

“Uremic acidosis” is not indexed as a one-term entity. Code “uremia” and “acidosis” as separate one-term entities, each of which can stand alone as a diagnosis.

I (a) Uremia N19

(b) Diabetic heart disease E149 I519

(c)

“Diabetic heart disease” is not indexed as a one-term entity. Code “diabetic” and “heart disease” as separate one-term entities, each of which can stand alone as a diagnosis.

I (a) Senile cardiovascular disease, MI R54 I516 I219

(b)

(c)

“Senile cardiovascular disease.” is not indexed as a one-term entity. Code “senile” and “cardiovascular disease” as separate one-term entities each of which can stand alone as a diagnosis.

Exception:

When any condition classifiable to I20-I25, except I250, or I60-I69 is qualified as “hypertensive,” code to I20-I25 or I60-I69 only.

I (a) Hypertensive arteriosclerotic

cerebrovascular disease I672

I (a) Hypertensive myocardial ischemia I259

(1) Code an adjective reported at the end of a diagnostic entity as if it preceded the entity. This applies whether reported in Part I or II.

I (a) Arteriosclerosis, hypertensive I10 I709

(b)

(c)

The complete term is not indexed as a one-term entity. “Hypertensive” is an adjectival modifier; code as if it preceded the arteriosclerosis.

I (a) MI I219

(b)

(c)

II Coronary occlusion, arteriosclerotic I709 I219

“Coronary occlusion, arteriosclerotic” is not indexed as a one-term entity. Arteriosclerotic is an adjectival modifier; code as if it preceded the coronary occlusion.

(2) (a) When a multiple one-term entity indicates a condition involving different sites or systems for which the Classification provides different codes, code the condition of each site or system separately.

I (a) Cardiac, respiratory, hepatic, renal failure I509 J969 K7290 N19

Code each site separately since the Classification provides a different code for each site.

(b) Where there is provision for coding the condition of one or more but not all of the sites or systems, code the conditions of the site(s) or system(s) that are indexed. Disregard the site(s) or system(s) for which the Classification does not provide a code.

I (a) Cerebro-hepatic failure K7290

“Hepatic failure” is the only term indexed. Do not enter a code for “cerebral failure.”

I (a) Ischemia colon, liver and spleen K559 I99

(b)

“Ischemia colon” is the only term indexed. Since liver and spleen are not indexed and the condition has an NOS code, assign the NOS code for these terms.

c. Adjectival modifier reported with multiple conditions

(1) If an adjectival modifier is reported with more than one condition, modify only the first condition.

I (a) Arteriosclerotic cardiomyopathy

and nephritis I251 N059

I (a) Diabetic coma and gangrene E140 R02

(2) If an adjectival modifier is reported with one condition and more than one site is reported, modify all sites.

I (a) Diabetic gangrene of hands and feet E145

I (a) Arteriosclerotic cardiovascular and I250 I672

cerebrovascular disease

(3) When an adjectival modifier precedes two different diseases that are reported with a connecting term, modify only the first disease.

I (a) Arteriosclerotic cardiovascular disease I250 I679

and cerebrovascular disease

2. Parenthetical entries

a. When one medical entity is reported, followed by another complete medical entity enclosed in parenthesis, disregard the parenthesis and enter as separate terms.

I (a) Heart dropsy I500

(b) Renal failure (CVRD) N19 I139

Code each medical entity as indexed.

Place I (a) Pneumonia (aspiration) J189 T179 &W80

Code each medical entity as indexed.

b. When the adjectival form of words or qualifiers are reported in parenthesis, use these adjectives to modify the term preceding it.

I (a) Collapse of heart I509

(b) Heart disease (rheumatic) I099

(c)

Use the adjective to modify the term and code rheumatic heart disease.

c. If the term in parenthesis is not a complete term and is not a modifier, consider as part of the preceding term.

I (a) Metastatic carcinoma (ovarian) C56

Consider the site as part of the preceding term and code metastatic ovarian carcinoma.

I (a) Drug dependence (heroin) (cocaine) F112 F142

Consider the specified drugs as part of the preceding term and code heroin and cocaine dependence.

Place I (a) Acute combination drug intoxication including T509 &X44 T404 T401 T436

9 (b) fentanyl, opiate (probably heroin) and methamphetamine

Consider the heroin as part of the preceding term and code heroin intoxication. There’s no need to assign opiate separately.

3. Special diagnostic entities

a. When a condition is qualified as “HIV-related,” “HIV,” disregard the indexing of these conditions and code as separate one-term entities.

I (a) HIV-related encephalopathy B24 G934

I (a) AIDS-related tuberculosis B24 A1690

I (a) AIDS encephalopathy B24 G934

I (a) HIV encephalopathy B24 G934

b. Alzheimer dementia: Consider the following terms as one term entities and code as indicated:

When reported as: Code

Endstage Alzheimer, senile dementia

Senile dementia, Alzheimer G301

Senile dementia, Alzheimer type

Senile dementia of the Alzheimer

When reported as:

Alzheimer, dementia

Alzheimer; dementia

Alzheimer disease (dementia)

Dementia Alzheimer

Dementia, Alzheimer

Dementia-Alzheimer

Dementia, Alzheimer type G309

Dementia of Alzheimer

Dementia-Alzheimer type

Dementia; Alzheimer type

Dementia, probable Alzheimer (disease)

Dementia syndrome, Alzheimer type

Endstage dementia (Alzheimer)

4. Plural form of disease

Do not use the plural form of a disease or the plural form of a site to indicate multiple.

I (a) Cardiac arrest I469

(b) Congenital defects Q899

Code I(b) Q899 (congenital defect); do not code as multiple (Q897).

5. Implied “disease”

When an adjective or noun form of a site is entered as a separate diagnosis, i.e., it is not part of an entry immediately preceding or following it, assume the word “disease” after the site and code accordingly.

I (a) Congestive heart failure I500

(b) Myocardial I515

Code I(b) to I515, myocardial disease. The site “myocardial” is not indexed with congestive heart failure.

I (a) Coronary I251

(b) Hypertension I10

Code I(a) to I251, coronary disease. Coronary hypertension is not indexed.

I (a) Renal I129

(b) Hypertension

Code I(a) to I129, renal hypertension. Consider the site, renal, to be a part of the condition that immediately follows it on line b, since Hypertension, renal is indexed.

6. Drug dependent, drug dependency

When drug dependent or drug dependency modifies a condition, consider as a non-codable modifier unless indexed.

I (a) Perforated gastric ulcer K255

(b) Steroid-dependent COPD J449

Code I(a) as indexed. Code I(b) to J449, chronic obstructive pulmonary disease NOS. Consider the “steroid dependent” to be a non-codable modifier.

C. Format

1. “Due to” relationships involving more than four causally related conditions

Four lines, (a), (b), (c), and (d) have been provided in Part I of the death certificate for reporting conditions involved in the sequence of events leading directly to death and for indicating the causal relationship of the reported conditions. In cases where the decedent had more than four causally related conditions leading to death, certifiers have been instructed to report all of these conditions and to add line, (e), to indicate the relationship of the conditions. In the ACME system, provision has been made for identifying conditions reported on the additional “due to” line in Part I. Code conditions reported on line (e) or in equivalent “due to” positions as having been reported on separate lines. (Refer to Section II, Part I, 2, Reject code 9 - More than four “due to” statements, for instructions for coding certificates with conditions reported on more than five “due to” lines.)

I (a) Shock due to pneumonia R579

(b) Rupture of esophageal varices J189

(d) K746

(e) F102

2. Connecting terms

a. “Due to” written in or implied

When the certifier has stated that one condition was due to another or has used another connecting term that implies a due to relationship between conditions in Part I, enter the codes as though the conditions had been reported, one due to the other, on separate lines. Code the conditions on each of the remaining lines in Part I, if there are any, as though they had been reported on the succeeding line. (Refer to Section II, Part I, 2, Reject code 9 - More than four “due to” statements, for instructions for coding certificates with more than four “due to” statements).

I (a) Myocardial infarction as a result of I219

(b) ASHD I251

Interpret “as a result of” as “due to” and code the ASHD on I(b).

I (a) Stomach hemorrhage from gastric ulcer K922

(b) Cholecystitis K259

Because of the implied “due to,” code the gastric ulcer on I(b) and the cholecystitis on I(c).

(1) The following connecting terms should be interpreted as meaning “due to” or “as a consequence of” when the entity immediately preceding and following these terms is a disease condition, nature of injury, or an external cause.

after incident to received in

arising in or during incurred after resulting from

as (a) complication of incurred during resulting when

as a result of incurred in secondary to (2°)

because of incurred when subsequent to

caused by induced by sustained as

complication(s) of occurred after sustained by

during occurred during sustained during

etiology occurred in sustained in

following occurred when sustained when

for occurred while sustained while

from origin 2/2

in received from

I (a) Myocardial infarction I219

(b) Nephritis due to arteriosclerosis N059

(d) I10

(e) E050

Both “due to” and “from” indicate the conditions following these terms are moved to the next due to position.

I (a) Neurological devastation due to stroke

(b) I64

Neurological devastation is a disease condition. Move stroke down to the next due to position.

I (a) Death from heart attack I219

(b)

Death is not a disease condition, nature of injury, or external cause. Do not reformat heart attack.

I (a) Complication from diabetes E149

Complication is not a disease condition, nature of injury, or external cause. Do not reformat diabetes.

I (a) Septic complications of AIDS B24

Since septic complications is not a disease condition, nature of injury, or external cause, do not reformat AIDS.

I (a) Cardiac arrest secondary to brain tumor I469

(b) D432

Code the brain tumor on I(b) since “due to” indicates it is moved to the next due to position.

(2) When one of the previous terms is the first entry in Part II, indicating that the following entry is a continuation of Part I, code in Part I in next due to position.

I (a) Respiratory failure J969

(b) Cardiac arrest I469

(d) I251

II due to ASHD

Since Part II is indicated to be a continuation of Part I, code the ASHD on I(d).

(3) Certain connecting terms imply that the condition following the connecting term was “due to” the condition preceding it. In such cases, enter the code for the condition following the connecting term on the line above that for the condition that preceded it.

Interpret the following connecting terms as meaning that the condition following the term was due to the condition that preceded it:

as a cause of manifested by

cause of producing

caused resulted in

causing resulting in

followed by underlying

induced with resultant

leading to with resulting

led to

I (a) Myocardial infarction followed by I469

(b) Cardiac arrest I219

(c)

Code the cardiac arrest on I(a) since “followed by” indicates it was due to the myocardial infarction.

I (a) Respiratory arrest R092

(b) Pulmonary edema J81

(d) and cardiac arrest J40

Code the pneumonia and cardiac arrest on I(c) since “with resulting” indicates they were due to the bronchitis.

b. Not indicating a “due to” relationship

When conditions are separated by “and” or by another connecting term that does not imply a “due to” relationship, enter the codes for these conditions on the same line in the order that the conditions are reported on the certificate.

The following terms imply that conditions are meant to remain on the same line

and (&) consistent with

accompanied by with ( c )

also precipitated by

associated with predisposing (to)

complicated by superimposed on

complicating

I (a) Acute bronchitis superimposed on J209 J439

(b) Emphysema

Interpret “superimposed on” as “and.” Enter the code for the condition on I(b) as the second code on I(a). Do not enter a code on I(b).

I (a) MI I219

(b) ASHD I251

(d) Diabetes E149 E142

II also diabetic nephropathy

Consider “also” as a connecting word that does not imply “due to” and code Part II as a continuation of I(d).

3. Condition reported as due to I(a), I(b), or I(c)

When a condition(s) in Part I is reported with a specific statement interpreted or stated as “due to” another on lines I(a), I(b), I(c), or I(d), rearrange the codes according to the certifier’s statement. Do not apply this instruction to such statements reported in Part II.

I (a) Myocardial failure I249

(b) Pneumonia I509

due to (a) 3wks

Accept the certifier’s statement that the condition reported on I(c) is “due to” the condition on I(a). Move the codes for conditions reported on I(a) and I(b) downward. (Apply the duration on I(c) to the myocardial ischemia).

I (a) Heart failure I509 N19

(b) Pneumonia J189

Take into account the certifier’s statement on I(c) and code the condition reported on I(c) as the second entry on I(a).

I (a) Carcinomatosis I469

(b) Cancer of lung C80

to above

Take into account the certifier’s statement and code the cardiorespiratory arrest on I(a), then move the codes for the remaining conditions downward.

I (a) Coronary thrombosis I219

(b) Chronic nephritis N039

II Uremia caused by above N19

Disregard the certifier’s statement, “caused by above,” reported in Part II.

I (a) Cancer of lung J189

(b) Pneumonia due to #1 C349

(c)

Take into account the certifier’s statement and code the pneumonia reported on I(b) as due to the cancer of lung.

4. Numbering of causes reported in Part I

a. When the certifier has numbered all causes or lines in Part I, that is 1, 2, 3, etc., code these entries as if reported on the same line. This instruction applies whether or not the numbering extends into Part II, and it also applies whether or not the “due to” below lines I(a) and/or I(b) and/or I(c) are marked through.

I (a) 1. Coronary thrombosis I219 I250 I10 I709 N289 J1110

(b) 2. ASCVD

(d) 4. Renal disease

II 5. Influenza

Code all the entries on I(a).

b. When part of the causes in Part I are numbered, make the interpretation for coding such entries on an individual basis.

I (a) 1. Bronchopneumonia J180 C169

(b) 2. Cancer of stomach

Enter the codes for the conditions numbered “1” and “2” on I(a) in the order indicated by the certifier. Do not enter a code on I(b); however, enter the code for the condition on I(c) on that line.

I (a) Bronchopneumonia J180

(b) 1. Cancer of stomach C169 N039

Enter the codes for conditions numbered “1” and “2” on I(b) in the order indicated by the certifier. Do not enter a code on I(c).

I (a) Congestive heart failure I500

(b) Influenza J1110

(d) 2. COPD

II 3. Cancer of lung

Enter the codes for the conditions numbered 1, 2, and 3 on I(c) in the order indicated by the certifier. Do not enter a code on I(d) or in Part II.

c. When the causes in Part I are numbered, and an entry is stated or implied as “due to” another, enter the code(s) connected by the stated or implied “due to” in the next “due to” position, followed by the codes for the remaining numbered causes.

I (a) 1. Bronchopneumonia due to J180

(b) influenza J1110 J841 J40

Enter the code for the condition followed by the stated “due to” on I(b), followed by codes for the conditions numbered “2” and “3.” Do not enter a code on I(c).

I (a) 1. Pneumonia J189

(b) MI I219 I251

Code the condition numbered “2” as a continuation of I(b). Leave I(c) blank.

5. Punctuation marks

a. Disregard punctuation marks such as a period, comma, question mark, or exclamation mark when placed at the end of a line in Part I. Do not apply this instruction to a hyphen (-), which indicates a word is incomplete.

I (a) Myocardial infarct, I219

(b) Meningitis, mastoiditis G039 H709

Disregard the punctuation marks and code the conditions reported on I(a), I(b), and I(c) as indicated by the certifier.

I (a) Chronic rheu- I099 I958

(b) matic heart disease, chronic hypotension

Regard the conditions reported on I(b) as a continuation of I(a). Do not enter a code on I(b).

b. When conditions are separated by a slash (/), code each condition as indexed.

I (a) Cardiac arrest/respiratory I469 R092 J189

arrest/pneumonia

(b) ASHD I251

Disregard the slash and code conditions as indexed.

c. When a dash (-) or slash (/) is used to separate sites reported with one condition and the combination of the sites is indexed to a single ICD-10 code, disregard the punctuation and code as indexed. This does not apply to commas.

I (a) Cardiac-respiratory arrest I469

Code as one code assignment since the 2 sites are indexed as Arrest, cardiorespiratory.

I (a) Cardiac, respiratory arrest I469 R092

Code each site separately since this instruction does not apply to commas.

I (a) Cardiac respiratory arrest I469

Code as one code assignment since the 2 sites are indexed as Arrest, cardiorespiratory.

d. When conditions are indexed together yet separated by a comma, code conditions separately. If the term following the comma is an adjective, refer to Section II, Part B, 1, b (1).

I (a) Cancer, cachexia C80 R64

(b) Anxiety, depression F419 F329

Code each term separately even though indexed together.

6. Conditions in the duration box

When a condition is entered in the duration block, code the condition on the same line where it is reported.

Duration

I (a) Arteriosclerotic heart disease CVA I251 I64

(b)

(c)

II Arteriosclerosis I709

Code the condition reported in the duration block as the last entry on I(a).

D. Doubtful diagnosis

1. Doubtful qualifying expression

a. When expressions such as “apparently,” “presumably,” “?,” “perhaps,” and “possibly,” qualify any condition, disregard these expressions and code condition as indexed.

I (a) ? hemorrhage of stomach K922

(b) Possible ulcer of stomach K259

Disregard “?” and code hemorrhage of stomach on I(a) as reported.
Disregard “possible” and code ulcer of stomach on I(b) as reported.

I (a) Heart disease, probable ASHD I519 I251

Disregard “probable” and code heart disease and ASHD on I(a).

Place I (a) Pneumonia, probably aspiration J189 T179 &W80

Disregard the “probably” and code both pneumonia and aspiration as indexed.

b. When these expressions are reported at the end of a line in Part I, do not consider to be a continuation of the next lower line.

I (a) Heart disease probably I519

(b) Acute myocardial infarction I219

Disregard “probably” and code heart disease on I(a) and acute myocardial infarction on I(b).

I (a) Cardiovascular disease presumably I516

(b) Cerebral thrombosis I633

Disregard “presumably” and code each condition on the line where it is reported.

c. When these expressions are reported at the beginning of a line in Part I, do not consider to be a continuation of the line above it.

I (a) Heart disease I519

(b) Possibly acute myocardial infarction I219

Disregard “possibly” and code each condition on the line where it is reported.

d. When these expressions are reported at the beginning of Part II, do not consider to be a continuation of Part I.

I (a) Heart disease probably I519

(b)

(c)

II Probably MI I219

Disregard “probably” and code heart disease on I(a) and MI in Part II.

2. Interpretation of “either…or…”

Consider the following as a statement of “either or:”

• Two conditions reported on one line and both conditions qualified by expressions such as “apparently,” “presumably,” “?,” “perhaps,” and “possibly”

• Two or more conditions connected by “or” or “versus”

Code using the following instructions:

a. When a condition of more than one site is qualified by a statement of “either…or…” and both sites are classified to the same system, code the condition to the residual category for the system.

I (a) Pneumonia J189

(b) Cancer of kidney or bladder C689

Code I(b) C689, malignant neoplasm of other and unspecified urinary organs.

I (a) Heart failure I509

(b) Coronary or pulmonary blood clot I749

Code I(b) I749, blood clot.

b. When a condition of more than one site is qualified by a statement of “either…or…” and these sites are in different systems, code to the residual category for the disease or condition specified.

I (a) Cardiac arrest I469

(b) Carcinoma of gallbladder C80

or kidney

Code I(b) C80, malignant neoplasm without specification of site.

I (a) Respiratory failure J969

(b) Congenital anomaly of heart Q899

or lungs

Code I(b) Q899, anomaly, congenital, unspecified.

c. When conditions are qualified by a statement of “either…or…” and only one site/system is involved, code to the residual category for the site/system.

I (a) Apparently stroke, perhaps heart attack I99

Since both conditions are preceded by a doubtful qualifying expression, consider as a statement of “either…or….” Stroke and heart attack are classified to the circulatory system. Code to Disease, circulatory system, NEC.

I (a) Pulmonary edema J81

(b) Tuberculosis or cancer of lung J9840

Code I(b) J9840, lung disease NOS.

Note: When embolism and thrombosis are qualified by a statement of “either…or…,” code to Clot (I749)

I (a) Cardiac thrombosis vs pulmonary embolism I749

Code I(a) I749, Clot (blood). Embolism and thrombosis are both blood clots, and Clot NOS is a more specific category than Disease, circulatory system.

d. When conditions are classified to the same three character category with different fourth characters, code to the three character category with fourth character “9.”

I (a) ASCVD vs ASHD I259

Code to I259 the residual category. ASCVD and ASHD are both classified to 125.-, chronic ischemic heart disease.

e. When conditions are classified to different three character categories and Volume 1 provides a residual category for the diseases in general, code to that residual category.

I (a) MI vs coronary aneurysm I259

Code to I259 the residual category for ischemic heart disease. MI and coronary aneurysm are both classified as “ischemic heart diseases.”

f. When conditions involving different systems are qualified by “either… or…,” and cannot be classified to the residual category for the disease, code R688, other specified general symptoms and signs.

I (a) Coma R402

(b) ? gallbladder colic ? coronary R688

thrombosis

Code I(b) R688, other ill-defined conditions. (Consider the two question marks on a single line as “either…or…”).

g. When diseases and injuries are qualified by “either… or…,” code R99, other unknown and unspecified cause, provided this is the only entry on the certificate. When other classifiable entries are reported, omit R99.

I (a) Head injury or CVA R99

Code I(a) R99, other unknown and unspecified cause.

h. For doubtful diagnosis in reference to “either… or…” accidents, suicides, and homicides, refer to Section V, Part A, External Cause Code Concept.

E. Conditions specified as “healed” or “history of”

The Classification provides sequela categories for certain conditions qualified as “healed” or “history of.” Refer to Section IV, Part F, Sequela. When the Classification does not provide a code or a sequela category for a condition qualified as “healed” or “history of,” code the condition as though not qualified by this term. Note that terms qualified as “family history of” are indexed to Z-codes which are invalid for mortality and so are not coded.

I (a) Myocardial infarction I219

(b)

(c)

II Gastritis, healed K297

Code K297, gastritis NOS in Part II.

F. Coding entries such as “same,” “ ditto ("),” “as above”

When the certifier enters “same,” “ditto mark ("),” “as above,” etc., in a “due to” position to a specified condition, do not enter a code for that line.

I (a) Coronary occlusion I219

(b) Same

Do not enter a code on I(b) for the entry “same.”

I (a) Pneumonia J189

(b) "

Do not enter a code on I(b) for the “ ditto mark (").”

G. Conditions qualified by “postmortem,” “rule out,” “ruled out,” “r/o”

When a condition is qualified by “postmortem,”, “rule out,” “ruled out”, or “r/o,” etc., do not enter a code for the condition.

H. Nonindexed and illegible entries

1. Terms that are not indexed

When a term is reported that does not appear in the ICD-10 Index, submit for consideration following the current technical assistance protocol.

2. Illegible entries

When an illegible entry is the only entry on the certificate, code R99. When an illegible entry is reported with other classifiable entries, disregard the illegible entry and code the remaining entries as indexed.

I. Coding one-character reject codes

When a death record qualifies for more than one reject code, code only one in this order: 1, 2, 3, 4, 5, 9.

1. Reject code 1-5-Inconsistent duration

When a duration of an entity in a “due to” position is shorter than that of an entity reported on a line above it and only one codable entity is reported on each of these lines, enter a reject code (1-5) in the appropriate data position. When more than one codable entity is reported on the same line, disregard the duration entered on that line. Use the appropriate reject code even though there are lines without a duration or with more than one codable entity between the entities with the inconsistent duration; in such cases, consider the inconsistency to be between the line immediately above and the line with the shorter duration.

If the inconsistent duration is between:

Lines ............................................................................................. Enter Reject Code

I (a) and I (b)......................................................................................................... 1

I (b) and I (c)......................................................................................................... 2

I (c) and I (d)......................................................................................................... 3

I (d) and I (e)......................................................................................................... 4

Inconsistent durations between more than two lines in Part I,
or any situation where reject codes 1-4 would not be applicable...................................... 5

Do not enter a reject code if the only inconsistency is between the durations of malignant neoplasms classifiable to C00-C96.

I (a) ASHD 10 yrs. I251

(b) Chronic nephritis and hypertension 5 yrs. N039 I10

Reject 2

Disregard the duration on I(b), since more than one codable entity is reported on this line. Only one codable entity is reported on lines I(a) and I(c) and the duration of the diabetes was shorter than that of ASHD. For the purposes of assigning the reject code, consider the duration on I(b) to be at least as long as the duration on I(a). Therefore, enter reject code 2 denoting an inconsistency between I(b) and I(c).

I (a) ASHD 5 yrs I251

(b) Chronic nephritis and hypertension 10 yrs N039 I10

Do not enter reject code 2. The duration on I(b) is disregarded. The duration of diabetes on I(c) was not shorter than that of ASHD on I(a).

I (a) Cardiac arrest I469

(b) Congestive heart failure 1 week I500

(d) Metastatic cancer of lung 6 months C780

Do not use reject code 3 since the inconsistent duration is between malignant neoplasms.

I (a) Basilar artery thrombosis 7 weeks I630

(b) Renal failure 4 weeks N19

Reject 5

Enter reject code 5 since the inconsistent durations are between more than 2 lines.

Age 1 yr.

I (a) Congenital nephrosis life N049

(b)

Reject 5

Enter reject code 5 since reject codes 1-4 are not applicable.

2. Reject code 9 - More than four “due to” statements

When certifier’s entries or reformatting result in more than four statements of “due to,” continue the remaining codes horizontally on the fifth line and enter reject code 9 in the appropriate position.

I (a) Terminal pneumonia J189

(b) Congestive heart failure I500

(d) ASHD I251

(e) Generalized arteriosclerosis I709 E039

(f) Myxedema

Reject 9

Enter the code for the myxedema reported on the fifth “due to” line, I(f), following the code for the condition reported on this line (generalized arteriosclerosis). Enter reject code 9 in the appropriate data position.

If there are more than four “due to” statements in Part I and there is no codable condition reported on one or more lines, consider the condition(s) on each subsequent “due to” line as though reported on the preceding line. Enter reject code 9 only if, after reformatting, there are codable conditions on more than five lines.

I (a) Pneumonia J189

(b) Extended illness G839

(d) Hypertension due to I10

(e) adrenal adenoma D350

Do not enter reject code 9. Since extended illness is not a codable condition, enter the code for paralysis on I(b), the code for CVA on I(c), etc. As a result of the rearrangement of the conditions, there are codable conditions on only five lines.

When a death record qualifies for more than one reject, prefer a reject code for inconsistent durations over reject code 9.

J. Inclusion of additional information (AI) to mortality source documents

Code supplemental information when it modifies or supplements data on the original mortality source document.

1. When additional information (AI) states the underlying cause of a specified disease in Part I, code the additional information (AI) in a “due to” position to the specified disease.

I (a) Pulmonary edema J81

(b) Congestive heart failure I500

(d) I709

AI The underlying cause of the congestive heart failure was ASHD.

Since the certifier states the underlying cause of the congestive heart failure is ASHD, code I251 on I(c) and move the condition on I(c) to the next “due to” position.

2. When additional information (AI) modifies a disease condition, use the AI and code the disease modified by the AI in the position first indicated by the certifier.

I (a) Pneumonia J181

(b)

(c)

AI Lobar pneumonia

Code lobar pneumonia as the specified type of pneumonia on I(a) only.

3. When there is a stated or implied complication of surgery and the additional information indicates the condition for which surgery was performed, code this condition in a “due to” position to the surgery when reported in Part I and following the surgery when reported in Part II. Precede this code with an ampersand (&).

I (a) Coronary occlusion T818

(b) Gastrectomy &Y836

AI Gastrectomy done for gastric ulcer.

Code the condition necessitating the surgery on I(c) and precede this code with an ampersand.

I (a) Respiratory arrest R092

(b) Septicemia T814

(c)

II Uremia, cholecystectomy N19 &Y836 &K802

AI Surgery for gallstones

Code the condition necessitating the surgery following the E-code for surgery in Part II.

4. When additional information (AI) states a certain condition is the underlying cause of death, code this condition in Part I in a “due to” position (on a separate line) to the conditions reported on the original death record.

I (a) Cardiac arrest I469

(b) MI I219

(d) E149

AI U.C. was diabetes

Accept the certifier’s statement that the underlying cause of death was “diabetes,” and code this condition on I(d) in a “due to” position to the conditions originally reported in Part I.

5. When any morphological type of neoplasm is reported in Part I with no mention of a “site” and additional information specifies a site, code the specified site only on the line where the morphological type is reported.

I (a) Cancer C349

(b)

(c)

AI Cancer of lung

Code only the specified cancer (lung) on I(a).

6. When additional information states the primary site of a malignant neoplasm, code this condition in a “due to” position to the other malignant neoplasms reported in Part I.

I (a) Metastatic neoplasm C80

(b) Metastasis to liver C787

AI Colon was primary site.

Code the stated primary site on I(c) in a “due to” position to the other neoplasms reported in Part I.

I (a) Carcinomatosis C80

(b) C61

(c)

AI Prostate was probably the primary site.

Code the presumptive primary site (prostate) on I(b) in a “due to” position to the stated neoplasm reported on the original death certificate.

7. When the additional information does not modify a condition on the certificate, or does not state that this condition is the underlying cause, code the AI as the last condition(s) in Part II. Code AI reported on the certificate beginning with the uppermost downward and from left to right.

I (a) Coronary thrombosis I219

(b) HASCVD I119

(c)

II Hypertension I10 I709 I64 I258

AI Arteriosclerosis, CVA, old MI

The additional information does not modify conditions on the certificate. Code as the last entries in Part II.

Male, 30 minutes-Twin B

I (a) Immature P073

600 gm (b)

(c)

II Atelectasis P281 P015 P070

Code the additional information in the order reported, uppermost downward and from left to right.

K. Amended certificates

When an “amended certificate” is submitted, code the conditions reported on the amended certificate only.

L. Effect of age of decedent on classification

Always note the age of the decedent at the time the causes of death are being coded. Certain groups of categories are provided for certain age groups. There are several conditions within certain categories which cannot be properly classified unless the age is taken into consideration. Use the following terms to identify certain age groups:

1. NEWBORN OR NEONATAL means less than 28 days of age at the time of death.

Code any index term with the indention of “newborn,” “neonatal,” “neonatorum,” “perinatal,” “perinatal period,” “fetus or newborn,” or “fetal” (in this priority order) to the newborn category if the decedent is less than 28 days of age or there is evidence the condition originated in the first 27 days of life, even though death may have occurred later.

Female, 4 hours

I (a) Anoxia P219

(b) Cerebral hemorrhage P524

Since the age of decedent is less than 28 days, code anoxia of newborn, and cerebral hemorrhage of newborn.

Male, 31 days Duration

I (a) Pulmonary hemorrhage 26 days P269

(b)

Since the condition originated in the first 27 days of life, code as a newborn.

2. INFANT or INFANTILE means less than 1 year of age at the time of death

Male, 9 months

I (a) Pneumonia J189

(b) Osteomalacia E550

Since the decedent is less than 1 year of age at the time of death, code Osteomalacia, infantile.

3. CHILD or CHILDHOOD means less than 18 years of age at the time of death

Male, 11 years

I (a) Asthma J450

Code as Asthma, childhood.

4.Congenital anomalies (Q00-Q99)

Regard the conditions listed below as congenital and code to the appropriate congenital category if death occurred within the age limitations stated, provided there is no indication that they were acquired after birth.

a. Less than 28 days:

heart disease NOS

hydrocephalus NOS

Male, 27 days

I (a) Renal failure N19

(b) Hydrocephalus Q039

Code the hydrocephalus as congenital since the decedent was less than 28 days of age at the time of death.

b. Less than 1 year:

aneurysm (aorta) (aortic) cyst of brain

(brain) (cerebral) (circle of deformity

Willis) (coronary) displacement of organ

(peripheral) (racemose) ectopia of organ

(retina) (venous) hypoplasia of organ

aortic stenosis pulmonary stenosis

atresia valvular heart disease (any valve)

atrophy of brain

Female, 3 months

I (a) Pneumonia J189

(b) Cyst of brain Q046

Code cyst of brain as congenital since the age of the decedent is less than 1 year.

5. Congenital syphilis

Regard syphilis and conditions that are qualified as syphilitic as congenital and code to the appropriate congenital syphilis category if the decedent was less than two years of age.

Male, 16 mos

I (a) Syphilitic pneumonia A500

(b)

(c)

Code congenital syphilitic pneumonia since age is less than 2 years.

6. Age limitation

Some categories in ICD-10 are limited by provisions of the Classification to certain ages. Code the categories listed below only if the age at the time of death was as follows:

a. Age 28 days or over

A32 E14 J13 R00

A35 E162 J14 R01

A40 E561 J15 R048

A41 E63 J16 R090

A56 E834 J18 R092

A74 E835 J43 R11

B30 F10 J80 R17

B370 F11 J849 R230

B371 F12 J96 R233

B372 F13 J981 R290

B373 F14 J982 R40

B374 F15 J984 R50

B375 F16 J988 R53

B376 F17 K27 R56

B377 F18 K631 R58

B378 F19 K65 R60

B379 G473 K92 R633

D65 G700 L01 R680

D751 I48 L10 R681

E05 I49 L50

E10 I50 L530

E11 I61 M34

E12 I62 N390

E13 J12 N61

Male, age 25 days

I (a) Urinary tract infection P393

(b)

Code urinary tract infection, newborn since age is less than 28 days.

Female, age 27 days

I (a) Respiratory failure P285

(b)

(c)

Code respiratory failure, newborn since age is less than 28 days.

Female, age 28 days

I (a) Atelectasis J981

(b)

(c)

Code atelectasis, J981 since age is reported as 28 days.

b. Age under 1 year:

R95

c. Age 1 year or over:

R960

Age 1 year

I (a) Sudden infant death syndrome R960

d. Age 5 years or over:

X60-X84

Age 4 years

Place I (a) GSW to head Suicide S019 &W34

M. Sex limitations

Certain categories in ICD-10 are limited to one sex:

For Males Only For Females Only

B260 A34 M830

C60-C63 B373 N70-N98

D074-D076 C51-C58 N992-N993

D176 C796 O00-O99

D29.- D06.- P546

D40.- D070-D073 Q50-Q52

E29.- D25-D28 Q96

E895 D39.- Q97

F524 E28.- R87

I861 E894 S314

L291 F525 S374-S376

N40-N50 F53.- T192-T193

Q53-Q55 I863 T833

Q98 L292 Y424

R86 L705 Y425

S312-S313 M800-M801 Y76.-

M810-M811

__________________________________________________________________________

If the cause of death is inconsistent with the sex, code the cause of death to the minimum necessary to be acceptable for either gender.

Female, age 32

I (a) Cancer of prostate C80

(b)

(c)

Code to cancer NOS C80, which is acceptable for both male and female.

N. Effect of duration on assignment of codes

Before assigning codes, take into account any statements entered on the certificate in the spaces for duration since these statements may affect the code assignments for certain conditions.

1. Qualifying conditions as acute or chronic

a. Usually the duration should not be used to qualify the condition as “acute” or “chronic.”

Duration

I (a) Nephritis 2 years N059

Code nephritis as indexed. Do not use the duration to qualify the nephritis as chronic.

b. However, when assigning codes to certain conditions classified as “ischemic heart diseases” the Classification provides the following specific guidelines for classifying a condition with a stated duration as acute or chronic:

- acute or with a stated duration of 4 weeks or less

- chronic or with a stated duration of over 4 weeks

Duration

I (a) Acute myocardial infarction 3 mos. I258

(b)

(c)

Code Infarction, myocardium, chronic or with a stated duration of over 4 weeks, I258.

(1) For the purpose of interpreting these instructions:

Consider these terms: To mean:

brief

days

hours

immediate

instant 4 weeks or less

minutes or acute

recent

short

sudden

weeks (few) (several)

longstanding over 4 weeks

1 month or chronic

Duration

I (a) Aneurysm heart weeks I219

(b)

(c)

Code Aneurysm, heart, acute or with a stated duration of 4 weeks or less, I219. “Weeks” is interpreted to mean 4 weeks or less.

c. When the duration is stated to be “acute” or “chronic,” consider the condition to be specified as acute or chronic.

Duration

I (a) Heart failure 1 hour I509

(b) Bronchitis acute J209

Code “acute” bronchitis on I(b).

2. Subacute

In general, code a disease that is specified as subacute as though qualified as acute if there is provision in the Classification for coding the acute form of the disease but not for the subacute form.

I (a) Subacute pyelonephritis N10

Code subacute pyelonephritis to N10, acute pyelonephritis since there is no code for subacute pyelonephritis.

3. Exacerbation

Interpret "exacerbation" as an acute phase of a disease. Code "exacerbation" of a chronic specified disease to the acute and chronic stage of the disease if the Classification provides separate codes for "acute" and "chronic."

I (a) Exacerbation of leukemia C950

(b) Chronic lymphocytic leukemia C911

I (a) Exacerbation of chronic C910 C911

(b) lymphocytic leukemia

I (a) Chronic leukemia with conversion to C951 C950

(b) acute phase

I (a) Exacerbation of chronic N10 N119

(b) pyelonephritis

I (a) Exacerbation of bronchitis J209

(b)

I (a) Acute exacerbation of chronic J209 J42

(b) bronchitis

I (a) Chronic obstructive lung disease exacerbation J449 J441

(b)

Code the preceding examples to the acute and chronic stages of each specified disease since the Classification provides separate codes for the “acute” and “chronic.”

4. Acute and chronic

Sometimes the terms acute and chronic are reported preceding two or more diseases. In these cases, use the term (“acute” or “chronic”) with the condition it immediately precedes.

I (a) Chronic renal and liver failure N189 K7290

Code renal failure, chronic and liver failure NOS.

5. Qualifying conditions as congenital or acquired

Code conditions classified as congenital in the Classification as congenital, even when not specified as congenital if the interval between onset and death and the age of the decedent indicate that the condition existed from birth.

Female, age 2 years Duration

I (a) Pneumonia 1 week J189

(b) Heart disease 2 years Q249

Code the condition on I(b) as congenital since the age of the decedent and the duration of the condition indicate that the heart disease existed at birth.

Do not use the interval between onset and death to qualify conditions that are classified to categories Q00-Q99, congenital anomalies, as acquired.

Male, 62 years Duration

I (a) Renal failure 3 months N19

(b) Pulmonary stenosis 5 years Q256

Do not use the duration to qualify the pulmonary stenosis as acquired.

6. Two conditions with one duration

When two or more conditions are entered on the same line with one duration, disregard the duration and code the conditions as indexed.

Duration

I (a) Myocardial ischemia and 3 weeks I259 I500

congestive heart failure

(b) Hypertension 5 years I10

Disregard the duration on I(a) and code the myocardial ischemia as indexed.

Duration

I (a) MI due to nephritis 3 months I219

(b) Arteriosclerosis N059

Disregard the duration on I(a) and code myocardial infarction as indexed.

7. Conflict in durations

When conflicting durations are entered for a condition, give preference to the duration entered in the space for interval between onset and death.

Duration

I (a) Ischemic heart dz 2 weeks years I259

Use the duration in the block to qualify the ischemic heart disease.

8. Span of dates

Interpret dates that are entered in the spaces for interval between onset and death separated by a slash (/), dash (-), etc., as meaning from the first date to the second date. Disregard such dates if they extend from one line to another and there is a condition reported on both of these lines since the span of dates could apply to either condition.

Date of death 10-6-98 Duration

I (a) MI 10/1/98 - I219

(b) Ischemic heart disease 10/6/98 I259

Disregard duration and code each condition as indexed since the dates extend from I(a) to I(b).

Date of death 10-6-98 Duration

I (a) Aneurysm of heart 10/1/98 - 10/6/98 I219

(b)

Since there is only one condition reported, apply the duration to this condition.

Date of death 10-6-98 Duration

I (a) Ischemic heart disease 10/1/98 - 10/6/98 I249

(b) Arteriosclerosis I709

Apply the duration to I(a).

9. 99 in duration block

When 99 is entered in the duration block, interpret as unknown duration.

Duration

I (a) Myocardial infarction 99 weeks I219

Code Infarction, myocardial I219. Interpret the duration as unknown and do not code as chronic.

O. Relating and modifying conditions

1. Implied site of disease

Certain conditions are classified in the ICD-10 according to the site affected, e.g.:

atrophy enlargement obstruction

calcification failure perforation

calculus fibrosis rupture

congestion gangrene stenosis

degeneration hypertrophy stones

dilatation insufficiency stricture

embolism necrosis

(This list is not all inclusive)

Occasionally, these conditions are reported without specification of site. Relate conditions such as these for which the Classification does not provide a NOS code. Also relate conditions which are usually reported of a site. Generally, it may be assumed that such a condition was of the same site as another condition if the Classification provides for coding the condition of unspecified site to the site of the other condition. These coding principles apply whether or not there are other conditions reported on other lines in Part I. Apply the following instructions when relating a condition of unspecified site to the site of a specified condition:

a. General instructions for implied site of a disease

(1) Conditions of unspecified site reported on the same line:

(a) When conditions are reported on the same line, with or without a connecting term that implies a due to relationship, assume the condition of unspecified site was of the same site as the condition of specified site.

I (a) Congestive heart failure I500

(b) Infarction with myocardial I219 I515

(d) Coronary sclerosis I251

Code the infarction as myocardial, the site of the condition reported on the same line.

I (a) Aspiration pneumonia J690

(b) Cerebrovascular accident due to I64

Code the thrombosis as cerebral, the site of the condition reported on the same line.

I (a) Duodenal ulcer with internal hemorrhage K269 K922

Code Hemorrhage, duodenal (K922). Relate the internal hemorrhage to the site of the condition reported on the same line.

I (a) CVA with hemorrhage I64 I619

(b) MI I219

Code Hemorrhage, cerebral (I619). Relate the hemorrhage to the site of the condition reported on the same line.

(b) When conditions of different sites are reported on the same line, assume the condition of unspecified site was of the same site as the condition immediately preceding it.

I (a) ASHD, infarction, CVA I251 I219 I64

(b)

(c)

Code Infarction, heart (I219). Relate the infarction to the site of the condition immediately preceding it.

(2) Conditions of unspecified site reported on a separate line:

(a) If there is only one condition of a specified site reported either on the line above or below it, code to this site.

I (a) Massive hemorrhage K922

(b) Gastric ulceration K259

Code the hemorrhage as gastric. Relate hemorrhage to the site of the condition reported on I(b).

I (a) Uremia N19

(b) Chronic prostatitis N411

Code the hypertrophy as prostatic. Relate hypertrophy to prostate, the site of the condition reported on I (b).

I (a) Internal hemorrhage K868

(b) Pancreatitis K859

Code Hemorrhage, pancreas (K868). Relate the internal hemorrhage to the site of the condition reported on I(b).

(b) If there are conditions of different specified sites on the lines above and below it and the Classification provides for coding the condition of unspecified site to only one of these sites, code to that site.

I (a) Intestinal fistula K632

(b) Obstruction K566

Code the obstruction as intestinal since the Classification does not provide for coding obstruction of the peritoneum.

(c) If there are conditions of different specified sites on the lines above and below it and the Classification provides for coding the condition of unspecified site to both of these sites, code the condition unspecified as to site.

I (a) CVA I64

(b) Thrombosis I829

Code Thrombosis NOS on I(b). Do not relate the thrombosis since the Classification provides codes for both sites reported.

(3) Do not relate conditions which are not reported in the first position on a line to the line above. It is acceptable to relate conditions not reported as the first condition on a line to the line below.

I (a) Kidney failure N19

(b) Vascular insufficiency c thrombosis I99 I219

Code Thrombosis, cardiac (I219). Relate thrombosis to line below.

(4) When relating conditions to sites start at the top of the certificate and work down.

I (a) Hemorrhage R5800

(b) Necrosis K729

The hemorrhage cannot be related. Relate necrosis to liver (K729), the site of the hepatoma.

b. Relating specific categories

(1) When ulcer, site unspecified or peptic ulcer NOS is reported causing, due to, or on the same line with gastrointestinal hemorrhage, code peptic ulcer NOS (K279).

I (a) Gastrointestinal hemorrhage K922

(b) Peptic ulcer K279

(c)

Code peptic ulcer (K279). Do not relate to gastrointestinal.

I (a) Ulcer causing gastrointestinal hemorrhage K922

(b) K279

Code ulcer to peptic ulcer (K279).

(2) When ulcer NOS (L984) is reported causing, due to, or on the same line with diseases classifiable to K20-K22, K30-K31, and K65, code peptic ulcer NOS (K279).

I (a) Peritonitis K659

(b) Ulcer K279

Code Ulcer, peptic (K279).

(3) When hernia (K40-K46) is reported with disease(s) of unspecified site(s), relate the disease of unspecified site to the intestine.

I (a) Hernia with hemorrhage K469 K922

Code Hemorrhage, intestine.

(4) When calculus NOS or stones NOS is reported with pyelonephritis, code to N209 (urinary calculus).

I (a) Pyelonephritis with calculus N12 N209

Code calculus (N209) since it is reported with pyelonephritis.

(5) When arthritis (any type) is reported with

• contracture - code contracture of the site

• deformity - code deformity acquired of the site

If no site is reported or if site is not indexed, code contracture or deformity, joint.

I (a) Phlebitis I809

(b) Contractures M245

Code Contracture, joint (M245) since contracture lower limb is not indexed.

I (a) Pulmonary embolism I269

(b) Multiple deformities M219

Code deformity (acquired) of hip.

(6) When embolism, infarction, occlusion, thrombosis NOS is reported

• from a specified site - code the condition of the site reported

• of a site, from a specified site - code the condition to both sites reported

I (a) Congestive heart failure I500

(b) Embolism from heart I2190

Code I(b) embolism of heart (I2190).

I (a) Pulmonary embolism from leg veins I269

(b) I803

(c)

Code I(a) pulmonary embolism (I269) and I(b) leg veins embolism (I803).

(7) Relate a condition of unspecified site to the complete term of a multiple site entity. If it is not indexed together, relate the condition to the site of the complete indexed term.

I (a) Cardiorespiratory arrest c failure I469 R092

Code Failure, cardiorespiratory (R092). Relate failure to the complete term.

I (a) Cardiorespiratory arrest I469 I509

(b) c insufficiency

Code Insufficiency, heart (I509) since cardiorespiratory arrest is indexed to a heart condition. Relate insufficiency to the site of the complete term.

(8) When vasculitis NOS is reported, apply the general instructions for relating and modifying.

I (a) Renal failure N19

(b) Vasculitis I778

Code Vasculitis, kidney (I778). Relate vasculitis to the site reported on line I(a).

c. Exceptions to relating and modifying instructions

(1) Do not relate the following conditions:

Arteriosclerosis Neoplasms

Congenital anomaly NOS Paralysis

Hypertension Vascular disease NOS

Infection NOS (refer to Section III, #7)

I (a) Arteriosclerosis with CVA I709 I64

(b)

(c)

Code Arteriosclerosis NOS (I709).

I (a) Cardiac arrest I469

(b) Congenital anomaly Q899

(c)

Code congenital anomaly NOS (Q899).

I (a) Pneumonia J189

(b) Infection

(c)

Code Pneumonia (J189) on I(a). Do not enter a code on I(b).

I (a) Perforation esophagus K223

(b) Cancer C80

(c)

Code cancer NOS (C80).

(2) Do not relate hemorrhage when causing a condition of a specified site. Relate hemorrhage to site of disease reported on same line or on line below only.

I (a) Respiratory failure J969

(b) Hemorrhage R5800

Code Hemorrhage NOS. Do not relate to respiratory.

I (a) Respiratory failure J969

(b) Hemorrhage K922

Relate hemorrhage on I(b) to gastric on I(c) and code gastric hemorrhage.

(3) Do not relate conditions classified to R00-R99 except:

Gangrene and necrosis R02

Hemorrhage R5800

Regurgitation R11

Stricture and stenosis R688

I (a) Myocardial infarction with anoxia I219 R090

Code anoxia as indexed. Do not relate to heart since anoxia is classified to R090.

I (a) Pneumonia with gangrene J189 J850

Code the gangrene as pulmonary, the site of the disease reported on the same line since gangrene is one of the exceptions.

(4) Do not relate a disease condition that, by the name of the disease, implies a disease of a specified site unless it is obviously an erroneous code. If not certain, submit for consideration following current technical assistance protocol.

I (a) Cirrhosis, encephalopathy K746 G934

Do not relate encephalopathy to liver since the name of the disease implies a disease of a specific site, brain.

I (a) Pulmonary embolism I269

(b) Thrombophlebitis I809

Code thrombophlebitis (I809) as indexed. Do not relate thrombophlebitis since it is not usually reported of any site other than extremities.

I (a) Cerebral hemorrhage with herniation I619 G935

Relate herniation to brain since hernia NOS is classified to a disease of the digestive system (K469) and it seems illogical to have a brain disease paired with a digestive system disease.

Refer to Section V, Part D, Implied site of injury for instructions on relating the site of injuries to another site.

2. Coding conditions classified to injuries as disease conditions

a. Some conditions (such as injury, hematoma or laceration) of a specified organ are indexed directly to a traumatic category but may not always be traumatic in origin. Consider these types of conditions to be qualified as nontraumatic when reported as below, unless a statement on the certificate indicates the condition was traumatic:

• due to or on the same line with a disease

• due to: drug poisoning

drug therapy

If there is provision in the Classification for coding the condition that is considered to be qualified as nontraumatic as such, code accordingly. Otherwise, code to the category that has been provided for "Other" diseases of the organ (usually .8).

I (a) Laceration heart I518

(b) Myocardial infarction I219

(c)

Consider laceration of heart as nontraumatic and code to other ill-defined heart diseases.

I (a) Subdural hematoma I620

(b) CVA I64

(c)

Code Hematoma, subdural, nontraumatic (I620) as indexed.

I (a) Acute kidney injury N179

(b) Kidney disease N289

(c)

Code acute kidney injury to nontraumatic as indexed under Injury, kidney, acute.

I (a) MRSA sepsis A410

(b)

(c)

II AKI N179

Code Part I(a) as indexed under Septicemia, Staphylococcus, aureus. Code acute kidney injury in Part II to nontraumatic as indexed under Injury, kidney, acute.

I (a) Cardiorespiratory failure R092

(b) Intracerebral hemorrhage I619

Code subdural hematoma as nontraumatic since it is reported on the same line with a disease.

I (a) Liver failure K7290

(b) Cirrhosis with injury to liver K746 K768

(c)

Code injury to liver as nontraumatic since it is reported on the same line with a disease.

I (a) Cerebral arteriosclerosis with I672 I620

(b) subdural hematoma

Code subdural hematoma as nontraumatic since it is reported on the same line with a disease.

Place I (a) OBS F069

9 (b)

(c)

II HTN, diabetes, Traumatic brain injury I10 E149 S069 &X599

Code traumatic brain injury as indexed. Since qualified as traumatic, prefer the certifier’s statement and do not apply the instruction.

I (a) Fat embolism I749

(b) Pathological fracture M844

Code line (a) as non-traumatic since reported due to disease.

b. Some conditions are indexed directly to a traumatic category but the Classification also provides a nontraumatic code. When these conditions are reported due to or with a disease and an external cause is reported on the record or the Manner of Death box is checked as Accident, Homicide, Suicide, Pending Investigation or could not be determined, code the condition as traumatic.

Place I (a) Subdural hematoma S065

9 (b) CVA I64

(c)

MOD II &W18

Accident

Fell while walking

Code the subdural hematoma as traumatic since the manner of death is accidental.

Place I (a) Cardiorespiratory arrest I469

0 (b) Subdural hematoma S065

MOD II Advanced age R54 &W18

Accident

Home

Fell in her room striking head

Code the subdural hematoma as traumatic since the manner of death is accidental.

Place I (a) Cerebral hematoma with S068 I672

9 (b) cerebral arteriosclerosis

(c)

MOD II &X599

Accident

Code the cerebral hematoma as traumatic since the manner of death is accidental.

c. Some conditions are indexed directly to a traumatic category, but the Classification also provides a nontraumatic code. When these conditions are reported and the Manner of Death is Natural, code condition as nontraumatic unless the condition is reported due to or on the same line with an injury or external cause. This instruction applies only to conditions with the term “nontraumatic” in the Index. It does not apply to conditions in Section III, Intent of Certifier.

I (a) Subdural hematoma I620

(b)

MOD II

Natural

Code I(a) as nontraumatic since Manner of Death box states “Natural.”

Place I (a) Subdural hematoma I620

2 (b)

(c)

MOD II Hip fracture S720 &W19

Natural

Fell in hospital

Code I(a) as nontraumatic since Manner of Death box states “Natural.”

Place I (a) Subdural hematoma S065

2 (b) Open wound of head S019

MOD II Fell in hospital &W19

Natural

Code subdural hematoma as traumatic since it is reported due to an injury, disregarding Natural in the Manner of Death box.

SECTION III - INTENT OF CERTIFIER

In order to assign the most appropriate code for a given diagnostic entity, it may be necessary to take other recorded information and the order in which the information is reported into account. It is important to interpret this information properly so the meaning intended by the certifier is correctly conveyed. The objective is to code each diagnostic entity in accordance with the intent of the certifier without combining separate codable entities. The following instructions help to determine the intent of the certifier. Apply Intent of Certifier instructions to “See also” terms in the Index and to any synonymous sites or terms as well.

1. Other and unspecified gastroenteritis and colitis of unspecified origin (A099)

a. Code A090 (Gastroenteritis and colitis of infectious origin)

When reported due to:

A000-B99

R75

Y431-Y434

Y632

Y842

I (a) Enteritis A090

(b) Listeriosis A329

Code I(a) gastroenteritis and colitis of infectious origin, A090, since enteritis is reported due to a condition classified to A329.

EXCEPTION: When the enteritis is reported due to another infectious condition or an organism classified to A49 or B34, refer to Section III, 7. Organisms and Infections.

b. Code K529 (Noninfective gastroenteritis and colitis, unspecified)

When reported due to:

C000-K929

L272

M000-N999

P000-R749

R760-Y430

Y435-Y631

Y633-Y841

Y843-Y899

I (a) Enteritis K529

(b) Abscess of intestine K630

Code I(a) noninfective gastroenteritis and colitis, unspecified, K529, since enteritis is reported due to a condition classified to K630.

I (a) Colitis A099

Code I(c) gastroenteritis and colitis of unspecified origin, A099, as indexed.

2. Cavitation lung (A162)

Code J984 (Nontuberculous cavitation lung)

When reported due to:

A000-A099 G459-G98 O981-P369

A200-B199 H650-H709 P371-R825

B201-B89 H720-H739 R826

B91-F39 H950-J64 R827-R892

F531 J660-L599 R893

F55 L930-L932 R894-R961

F71-F79 M000-N459 R98-R99

F840-F849 N480-N96 S000-Y899

F99-G419 N980-O979

I (a) Cavitary lung disease J984

(b) COPD J449

Code I(a) nontuberculous cavitation of lung, J984, since cavitary lung disease is reported due to a condition classified to J449.

I (a) Respiratory failure J969

(b) Refractory shock R570

Code I(c) cavitation of lung, A162, since it is not reported due to any other conditions.

3. Spinal Abscess (A180)
Vertebral Abscess (A180)

Code M462 (Nontuberculous spinal abscess)

When reported due to:

A400-A419 H650-H669 M910-M939

A500 H950-H959 M960-M969

A509 J00-J399 N10-N12

A527 J950-J959 N136

A539 K650-K659 N151

B200-B24 K910-K919 N159

B89 L00-L089 N288

B99 M000-M1990 N340-N343

C412 M320-M351 N390

C760 M359 N700-N768

C795 M420-M429 N990-N999

C810-C969 M45-M519 R75

D160-D169 M600 S000-T983

D480 M860-M889

D550-D589 M894

I (a) Spinal Abscess M462

(b) Staphylococcal septicemia A412

Code I(a) nontuberculous spinal abscess, M462, since spinal abscess is reported due to a condition classified to A412.

4. Charcot Arthropathy (A521)

Code G98 (Arthropathy, neurogenic, neuropathic (Charcot), nonsyphilitic)

When reported due to:

A30 Leprosy G608 Hereditary sensory

E10-E14 Diabetes mellitus neuropathy

E538 Subacute combined degeneration G901 Familial dysautonomia

(of spinal cord) G950 Syringomyelia

F101 Alcohol abuse Q059 Spina bifida,

F102 Alcoholism meningo-myelocele

G600 Hypertrophic interstitial Y453 Indomethacin

neuropathy Y453 Phenylbutazone

G600 Peroneal muscular atrophy Y427 Corticosteroids

I (a) Charcot arthropathy G98

(b) Diabetes E149

5. General Paresis (A521)

a. Code G839 (Paralysis)

When reported due to or on the same line with:

A022 A988 B690 D180-D181 I159

A040 B003-B004 B719 D210 I600-I709

A051 B010-B011 B75 D233-D234 I748

A066 B020-B022 B832 D320-D339 J108

A078 B03-B04 B888 D352 J118

A170-A179 B050-B051 B89 D355 M000-M1990

A180 B060 B900 D360-D367 M420-M429

A190-A191 B200-B24 B901-B909 D420-D439 M45-M519

A203 B258 B91 D443 M860-M949

A228 B259 B92-B940 D446 N000-N399

A260-A289 B261-B262 B941 D448 O100-O16

A321-A329 B268 B948-B949 D45-D479 O740-O749

A368 B270-B279 C470 D487 O900-O909

A390-A394 B334-B338 C479 D489 O95

A398-A399 B375 C700-C729 E713 O994

A428 B384 C751 E750-E756 P000-Q079

A440-A539 B428 C754 F449 Q750-Q799

A544 B450-B459 C758 G000-G239 Q860-Q999

A548 B461 C760 G300-G379 R270-R278

A680-A689 B49-B64 C770 G450-G459 R75

A692 B673 C793-C794 G540-G729

A800-A959 B676 C798-C97 G839-G98

A981-A982 B679 D170 I10

I (a) CVA with general paresis I64 G839

(b)

(c)

b. Code T144 (Paralysis, traumatic)

Refer to Section V, Part S, Sequela of injuries, poisonings, and other consequences of external causes, if a sequela is indicated.

When reported due to or on the same line with:

S000-T149 W81-X39

T20-T35 X50-X599

T66-T79 X70-X84

T90-T95 X91-Y09

T981-T982 Y20-Y369

V010-W43 Y850-Y872

W45-W77 Y890-Y899

I (a) General paresis T144

(b) Brain injury S069

(c)

II Auto accident &V499

6. Viral Hepatitis (B161, B169, B171-B179)

Code

For Viral Hepatitis in Code Chronic Viral Hepatitis

Categories

B161 B180

B169 B181

B171 B182

B172 B188

B178 B188

B179 B189

When reported as causing liver conditions in:

K721, K7210

K740-K742

K744-K746

I (a) Cirrhosis of liver K746

(b) Viral hepatitis B B181

Code I(b) B181, chronic viral hepatitis B, since reported as causing a condition classified to K746.

7. Organisms and Infections NOS (B99)

Organisms

Bacterial organisms Viral organisms Organisms classified to

classified to A49.- classified to B34.- other than A49.- or B34.-

Escherichia coli Adenovirus Aspergillus

Haemophilus influenzae Coronavirus Candida

Pneumococcal Coxsackie Cytomegalovirus

Staphylococcal Enterovirus Fungus

Streptococcal Parvovirus Meningococcal

Infectious conditions

Abscess Infection Sepsis, Septicemia

Bacteremia Pneumonia Septic Shock

Empyema Pyemia Words ending in “itis”

These lists are NOT all inclusive. Use them as a guide.

In order to determine which instruction to use, refer to the Index under the named organism or under Infection, named organism.

a. Bacterial organisms and infections classified to A49 and Viral organisms and infections classified to B34

(1) When an infectious or inflammatory condition is reported and

(a) Is preceded or followed by condition classified to A49 or B34 or

(b) A condition classifiable to A49 or B34 is reported as the only entry or first entry on the next lower line or

(c) Is followed by a condition classified to A49 or B34 separated by a connecting term not indicating a due to relationship

(i) If a single code is provided for the infectious or inflammatory condition modified by the condition classified to A49 or B34, use this code. Do not assign a separate code for the condition classifiable to A49 or B34. It may be necessary to use “due to” or “in” in the Index to assign the appropriate code.

I (a) E. coli diarrhea A044

Code as indexed under Diarrhea, due to, Escherichia coli.

I (a) Pneumonia J129

(b) Viral infection

Code as indexed under Pneumonia, viral.

I (a) Meningitis and sepsis G000 A413

(b) H. influenzae

Code as indexed under Meningitis, Haemophilus (influenzae) and Septicemia, Haemophilus influenzae.

I (a) Sepsis with staph A412

Code as staphylococcal sepsis as indexed under Septicemia, staphylococcal.

I (a) Pneumonia c MRSA J152

Code as methicillin resistant staphylococcal aureus pneumonia as indexed under Pneumonia, MRSA.

(ii) If (i) does not apply, and the Index provides a code for the infectious or inflammatory condition qualified as “bacterial,” “infectious,” “infective,” or “viral,” assign the appropriate code based on the reported type of organism. Do not assign a separate code for the condition classified to A49 or B34.

I (a) Coxsackie virus pneumonia J128

Coxsackie virus is a specified virus. Code as indexed under Pneumonia, viral, specified NEC.

I (a) Peritonitis K650

(b) Campylobacter

Campylobacter is a specified bacteria. Code as indexed under Peritonitis, bacterial.

I (a) Pneumonia with coxsackie virus J128

Code as coxsackie virus pneumonia. Since coxsackie virus is a specified virus, code as indexed under Pneumonia, viral, specified NEC.

(iii) If (i) and (ii) do not apply, assign the NOS code for the infectious or inflammatory condition. Do not assign a separate code for the condition classified to A49 or B34.

I (a) Klebsiella urinary tract infection N390

The Index does not provide a code for Infection, urinary tract specified as bacterial, infectious, infective, or Klebsiella. Therefore, code Infection, urinary tract.

I (a) Pyelonephritis N12

(b) Staphylococcus

The Index does not provide a code for pyelonephritis specified as bacterial, infectious, infective, or staphylococcal. Therefore, code Pyelonephritis as indexed.

I (a) Pyelonephritis and pseudomonas N12

The Index does not provide a code for pyelonephritis specified as bacterial, infectious, infective or pseudomonas. Therefore, code pyelonephritis as indexed.

b. Organisms and infections classified to categories other than A49 and B34

(1) When an infectious or inflammatory condition is reported and

(a) Is preceded by a condition classifiable to Chapter I other than A49 or B34

(i) Refer to the Index under the infectious or inflammatory condition. If a single code is provided for this condition, modified by the condition from Chapter I, use this code. It may be necessary to use “due to” or “in” in the Index to assign the appropriate code.

I (a) Cytomegaloviral pneumonia B250

Code as indexed under Pneumonia, cytomegaloviral.

(ii) If (i) does not apply, refer to Volume 1, Chapter I to determine if the Classification provides an appropriate fourth character for the organism. Indications of appropriate fourth characters for sites would be “of other sites,” “other specified organs,” or “other organ involvement.”

I (a) Candidiasis peritonitis B378

Since this term is not indexed together, refer to Volume I, Chapter I and select the fourth character, .8, candidiasis of other sites.

(iii) If (i) and (ii) do not apply, code as two separate conditions.

I (a) Mononucleosis pharyngitis B279 J029

Since this term is not indexed together and Volume I, Chapter I does not provide an appropriate fourth character under B27.-, code as two separate conditions.

(b) A condition from Chapter I other than A49 or B34 is reported as the only entry or the first entry on the next lower line

(i) Code each condition as indexed where reported.

I (a) Peritonitis K659

(b) Candidiasis B379

Since candidiasis is classified to a condition other than A49 or B34, code each condition as indexed.

(c) A condition from Chapter I other than A49 or B34 is reported separated by a connecting term not indicating a due to relationship

(i) Code each condition as indexed where reported.

I (a) Pneumonia with candidiasis J189 B379

Since candidiasis is classified to a condition other than A49 or B34, code each condition as indexed.

c. Do not use HIV or AIDS to modify an infectious or inflammatory condition. Code as two separate conditions.

I (a) HIV pneumonia B24 J189

d. When an infectious or inflammatory condition is reported and a specified organism or specified nonsystemic infection is not the only entry or the first entry on the next lower line.

• Code the infectious or inflammatory condition and the organism or infection separately.

I (a) Pneumonia J189

(b) Emphysema & viral infection J439 B349

I (a) Peritonitis K659

(b) Gastric ulcer and staphylococcal infection K259 A490

e. When an infectious or inflammatory condition is reported and

(1) Infection NOS is reported as the only entry or the first entry on the next lower line

• Code the infectious or inflammatory condition where it is entered on the certificate and do not enter a code for infection NOS, but take into account if it modifies the infectious condition.

I (a) Cholecystitis & arthritis K819 M009

(b) Infection

I (a) Meningitis G039

(b) Infection & brain tumor D432

(2) Infection NOS is not the only entry or the first entry on the next lower line

• Code the infectious or inflammatory condition where it is entered on the certificate and code infection NOS separately.

I (a) Septicemia A419

(b) Diabetes & infection E149 B99

f. When a noninfectious or noninflammatory condition is reported and infection NOS is reported on a lower line

• Code the noninfectious or noninflammatory condition as indexed and code infection NOS (B99) where entered on the certificate.

I (a) ASHD I251

(b) Infection B99

g. When an organism is reported preceding two or more infectious conditions reported consecutively on the same line

• Code each of the infectious conditions modified by the organism.

I (a) Staphylococcal pneumonia and J152 G003

(b) meningitis

h. When one infectious condition is modified by more than one organism, modify the condition by all organisms.

I (a) Strep, Klebsiella and MRSA pneumonia J154 J150 J152

I (a) Strep pneumonia, MRSA J154 J152

I (a) Sepsis enterococcus, MRSA A402 A410

i. When any condition is reported and a generalized infection such as bacteremia, fungemia, sepsis, septicemia, systemic infection, or viremia is reported on a lower line

• Code both the condition and the generalized infection where entered on certificate. Do not modify the condition by the infection.

I (a) Bronchopneumonia J180

(b) Septicemia A419

I (a) Pneumonia J189

(b) Viremia B349

8. Eaton-Lambert syndrome (C80)

Code G708 (Eaton-Lambert syndrome unassociated with neoplasm)

When reported on a record without a condition from the following categories also reported:

C000-D489

            Male, 57 years old
            I   (a) Aspiration pneumonia                                                     J690
            (b) Eaton-Lambert syndrome                                                G708

Code I(b) Eaton-Lambert syndrome unassociated with neoplasm (G708) since there is no condition from categories C000 - D489 reported anywhere on the record.

Female, 69 years old

I (a) Eaton-Lambert syndrome C80
(b) Small cell lung cancer C349

Code I(a) Eaton-Lambert syndrome (C80) since there is a condition from categories C000 - D489 reported on the record.

9. Erythremia (C940)

Code D751 (Secondary erythremia):

When reported due to

A000-D489 F55 L710-L719 N700-N768 R730-R739

D510-D619 G000-G419 L930-L932 N980 R75

D751 G450-G459 L950-L959 N990-Q999 R780

D760-E149 G600-G979 M000-M1990 R030 R826

E240-E279 I00-J989 M300-M359 R040-R049 R893

E65-E678 K20-L00 M420-M549 R090-R098 S000-Y899

E890 L100-L139 M800-M949 R160-R162

E896-E899 L230-L309 M960-M969 R31

F100-F199 L500-L599 N000-N399 R58-R5800

I (a) Septicemia A419

(b) Erythremia D751

10. Polycythemia (D45)

Excludes:

idiopathic

primary

rubra

vera

Code D751 (Secondary polycythemia)

When reported due to:

A000-D489 F55 L710-L719 N700-N768 R730-R739

D510-D619 G000-G419 L930-L932 N980 R75

D751 G450-G459 L950-L959 N990-Q999 R780

D760-E149 G600-G979 M000-M1990 R030 R826

E240-E279 I00-J989 M300-M359 R040-R049 R893

E65-E678 K20-L00 M420-M549 R090-R098 S000-Y899

E890 L100-L139 M800-M949 R160-R162

E896-E899 L230-L309 M960-M969 R31

F100-F199 L500-L599 N000-N399 R58-R5800

I (a) Polycythemia D751

(b) Pneumonia J189

I (a) Polycythemia &D751

(b) Chloromycetin therapy Y408

I (a) Polycythemia vera D45

(b) Emphysema J439

11. Hemolytic Anemia (D589)

Code D594 (Secondary hemolytic anemia)

When reported due to:

A000-D489 F180-F199 Q200-Q289

D594 G000-G09 R75

D65-D699 I00-I519 R780

D760 I776 R823

D800-D899 J09-J22 R826

E201 K700-K769 R893

E280-E289 M000-M359 S000-Y899

E40-E46 N000-N399

E700-E899 O000-O998

F100-F169 P550-P579

I (a) Hemolytic anemia D594

(b) Hairy cell leukemia C914

(c)

I (a) Hemolytic anemia D589

(b)

(c)

II Hypogammaglobulinemia D801

I (a) Secondary hemolytic D594

(b) anemia

12. Sideroblastic Anemia (D643)

a. Code D641 (Secondary sideroblastic anemia due to disease)

When reported due to:

A000-C97 E230 F180-F182 J069 M023

D45 E531 F190-F192 J65 M101

D461 E539 F55 K700-K703 M352

D471 E798 G030 K709 N143

D510-D599 E800-E802 G040 K721 N188-N19

D640-D643 E831 G361 K730-K746 N341

D648 E880 G933 K760 O980-O981

D731 E890 I330 K761 R162

D748 F100-F102 I423 K766 R75

D758 F109-F112 I729 K769 R780

D860-D869 F119-F122 I888 K908 R826

D892 F130-F132 J00 L081 R893

E018-E02 F140-F142 J020 L448 R897

E032-E0390 F150-F152 J030 L946

E050-E059 F160-F162 J040-J042 M021

I (a) Pneumonia J189

(b) Sideroblastic anemia D641

b. Code D642 (Secondary sideroblastic anemia due to drugs or toxins)

When reported due to:

D642 X60-X69

T510-T659 Y10-Y19

T97 Y400-Y599

X40-X49 Y86-Y880

I (a) CHF I500

(b) Sideroblastic anemia &D642

13. Hemorrhagic Purpura NOS (D693)

Code D690 (Hemorrhagic purpura not due to thrombocytopenia)

When reported due to:

A000-C97 F119 I771-I779 N19 Q848

D45-D460 F120 I872 N200-N219 Q872-Q873

D462-D469 F121-F122 I878 N250-N311 Q878

D471 F130-F132 I879 -I889 N312-N319 R104

D510 F140 I898-I899 N320-N390 R162

D511-D581 F141-F142 I99-J00 N392 R233

D582 F150 J020 N398-N399 R238

D588-D618 F151-F152 J030 N719 R291

D619 F160-F162 J040-J042 N897 R31

D648 F180-F181 J069 N910-N939 R398

D65-D692 F182 J65 N948 R72

D698-D71 F190-F191 K658 N950-N959 R75

D720 F192 K660 N991 R780

D721 G000-G032 K700-K769 P070-P073 R826

D728 G038-G039 K908 P219 R893

D729-D759 G040 L081 P221-P289 R897

D860-D869 G042-G049 L272 P546 T360-T658

D892 G060 L448 P916 T659

E240 G061-G09 L573 Q458 T780-T784

E241 G312 L80-L819 Q680 T789

E242 G361 L946 Q740-Q741 T806

E243 G373-G374 L958 Q758 T818

E248 G540 L959 Q772 T881

E249 G92 M021-M023 Q775-Q776 T885

E301 G933 M050-M089 Q778 T886-T887

E54 G958 M101 Q779-Q783 T96-T97

E569 G961 M120 Q785 T981

E642 I00-I019 M138 Q788-Q789 X20-X29

E648 I10 M159 Q791 X40-X48

E703 I159 M300 Q794-Q795 X49

E798 I308 M301-M352 Q796 X60-X69

E850-E859 I330-I339 M358 Q798 Y10-Y19

E871 I400-I409 M359 Q808 Y400-Y599

E880 I423 M898 Q810-Q819 Y86

F100 I729 N000-N078 Q820 Y870

F101-F102 I749 N079 Q821-Q825 Y871

F110-F112 I770 N10-N189 Q828 Y872

I (a) CVA I64

(b) Hemorrhagic purpura D690

14. Thrombocytopenia (D696)

Code D695 (Secondary thrombocytopenia)

When reported due to:

A000-D447 F110 J030 P350 -P399 T752

D448 F111-F112 J040-J042 P550 -P560 T780-T783

D449-D509 F119 J069 P570 T784

D510 F120 J09-J118 P610 T788-T789

D511-D691 F121-F122 J65 P614 T803-T804

D692 F130 K658 P916 T808-T809

D693-D699 F131-F132 K660-K661 Q204 -Q205 T818

D730-D752 F140 K700-K769 Q206 T881

D758 F141-F142 K908 Q208 T882 -T883

D759-D763 F150 K920-K921 Q209 T885

D814 F151-F152 K922 Q210 T886 -T888

D820 F160 L081 Q220 -Q246 T889

D821 F161-F162 L448 Q248 T950 -T97

D840 F180-F181 L590 Q249 T981

D841-D848 F182 L818 Q289 T983

D860-D892 F190-F191 L946 Q758 V010-V99

E000-E009 F192 M021 Q775-Q776 W00-W53

E018-E02 F55 M023 Q778 W54-W56

E031-E033 G000-G032 M050-M089 Q779-Q783 W57

E034 G038-G039 M101 Q788-Q789 W58-W87

E035-E0390 G040 M120 Q798 W88-W93

E055 G042-G048 M138 Q828 W94-X19

E059 G049-G060 M159 Q850 X20-X32

E071 G061-G09 M199-M1990 R001 X34-X39

E230 G312 M219 R008 X40-X48

E349 G361 M300 R012 X49-X599

E46 G373-G374 M301-M329 R161-R162 X65

E538 G450-G452 M352 R233 X69-Y369

E539-E54 G454-G459 M898 R291 Y400-Y601

E560-E639 G540 N000-N078 R31 Y603

E642 G903 N079 R398 Y605

E648 G92 N10-N219 R58-R5800 Y610-Y611

E649 G933 N250-N311 R75 Y613

E713 G936 N312-N319 R771 Y615

E740 G938 N320-N390 R780 Y617

E750 G951 N392 R788 Y620-Y621

E752 G958 N398-N399 R798 Y623

E753 G961 N980-N989 R825 Y625

E755-E756 I00-I019 N991 R826 Y630-Y633

E768-E779 I10-I629 O360-O369 R827-R828 Y640-Y655

E782 I630-I6300 O430-O431 R829 Y658

E798 I631-I6310 O438 R893 Y66-Y831

E803 I633-I677 O439-O469 R897 Y840

E835 I678-I679 O60 T200 Y842

E871 I690-I891 O670-O689 T201-T289 Y848-Y849

E880 I898 O700-O719 T300 Y850-Y872

E888 I899-I972 O908 T301-T329 Y880-Y881

E890 I978 O980-O981 T360-T658 Y890-Y891

E898 I99 P070-P073 T659 Y899

F100 J00 P219 T66-T670

F101-F102 J020 P221-P289 T68

I (a) Multiple hemorrhages R5800

(b) Thrombocytopenia D695

15. Hyperparathyroidism (E213)

Code E211 (Secondary hyperparathyroidism)

When reported due to:

A180 D136-D137

A187 D300-D309

A188 D351-D353

B650-B839 D410-D419

B902-B908 D442-D444

C250-C259 E130-E139

C64-C689 E15-E215

C750-C752 E240-E259

C788 E270-E279

C790-C791 E892

C798 M880-M889

C900-C902 N000-N399

D017 Q600-Q649

D090-D091 Q770-Q789

D093 Q798

I (a) Hypercalcemia E835

(b) Hyperparathyroidism E211

16. Hyperaldosteronism (E269)

Code E261 (Secondary hyperaldosteronism)

When reported due to:

A220-A229 E270-E46 I500-I509 T96-T97

B500-B54 E511-E519 I701 T983

B560-B575 E660-E669 I778 X40-X49

C740-C749 E713 K700-K709 X60-X69

C797 E86 K721-K7210 X85-X90

D093 E871 K730-K746 Y10-Y19

D350 E880 K850-K851 Y400-Y599

D441 E890 K853-K859 Y86-Y880

D448-D449 E892 N000-N399

D840-D849 E895-E899 T360-T659

E000-E249 I10-I150 T783

E250-E269 I159 T880-T889

I (a) MI I219

(b) Hyperaldosteronism E261

17. Lactase Deficiency (E730)

Code E731 (Secondary lactase deficiency)

When reported due to:

E730-E749 K590-K599

K500 K630

K508-K510 K633

K519-K529 K639

K570 K900-K902

K574 K912

K580-K589 N200-N209

I (a) Severe diarrhea K529

(b) Lactase deficiency E731

Code I(b) secondary lactase deficiency, E731, since reported due to celiac disease.

18. Korsakov Disease, Psychosis, or Syndrome (F106)

Code F04 (Nonalcoholic Korsakovs disease, psychosis, or syndrome)

When reported due to :

A000-D591 L920 S710-S729 T904

D592 L928-L932 S740-S799 T905

D593-D610 L951 S810-S829 T908

D611 L980-L981 S840-S899 T909

D612-E243 M000-N459 S910-S929 T910

E248-E519 N490-N809 S940-S999 T911-T915

E52 N990-N992 T012-T029 T918

E530-F09 N994-Q999 T041-T08 T919-T922

F200-G311 R54 T091 T924-T926

G318-G619 R75 T093-T10 T928

G620 S010-S029 T111 T929-T932

G622 S040-S050 T113-T12 T934-T936

G628-G720 S052-S099 T131 T938

G722-G98 S110-S129 T133-T139 T939

I00-I4250 S140-S199 T141-T142 T940-T953

I427-J989 S210-S229 T144-T329 T954

K20-K291 S240-S299 T340-T349 T958-T959

K293-K669 S310-S328 T351-T399 T96-X40

K710-K851 S340-S399 T410-T422 X43-X44

K853-K859 S410-S429 T425-T426 X46-Y449

K861-L109 S440-S499 T427 Y451-Y468

L129-L449 S510-S529 T428 Y480-Y485

L510-L599 S540-S599 T440-T509 Y500-Y899

L710-L719 S610-S628 T520-T889

L88 S640-S69 T901-T903

I (a) Korsakoff psychosis F04

(b) Wernicke encephalopathy E512

(c)

19. Drug Use NOS - Named Drug Use (F11-F16, F18-F19)

Code drug use NOS, F199, when reported anywhere on the certificate. Code use of named drug, F11-F16, F18-F19 with fourth character “9,” when reported anywhere on the certificate and the named drug is listed in Volume 3, under Addiction/Dependence. If the named drug is not listed in Volume 3 under Addiction/Dependence, do not enter a code.

Exceptions:

(1) Complication(s) reported due to (named) drug use. Code the (named) drug use to the appropriate external cause code for adverse effects of drugs in therapeutic use unless the drug is one not used for medical care purposes. Refer to Section V, Part R, 1, Drugs, medicaments, biological substances causing adverse effects in therapeutic use (Y40-Y59) for coding instructions.

(2) There is mention of drug poisoning anywhere on the certificate, code the (named) drug use to F11-F16, F18-F19, with fourth character “9,” if listed in Volume 3 under Addiction/Dependence. If (named) drug is not indexed in Volume 3 under Addiction/Dependence, code F19, specified drug NEC with fourth character “9.” Refer to Section V, Part Q, 2, Poisoning by drugs.

I (a) Chronic alcoholism F102

(b)

(c)

II Drug use F199

Code drug use to F199. There is no complication reported due to the drug use.

I (a) Cancer of pancreas C259

(b)

(c)

II Methadone use F119

Code methadone use to F119 as listed under Dependence in Volume 3. There is no complication reported due to the methadone use.

I (a) Systemic lupus erythematosus M329

(b)

(c)

II Steroid use

Do not code steroid use. Steroid is not listed in Volume 3 under Addiction/Dependence and no complication is reported due to the steroid use.

I (a) Diabetes E139

(b) Steroid use Y427

(c)

II Rheumatoid arthritis &M069

Code the diabetes as a complication of the steroids given in therapeutic use for rheumatoid arthritis. Refer to Section V, Part R, 1, Drugs, medicaments, biological substances causing adverse effects in therapeutic use (Y40-Y59) for coding complications of drugs during therapeutic use.

I (a) Bacterial endocarditis &I330

(b) Use of morphine Y450

(c)

Code the bacterial endocarditis as a complication of the morphine given in therapeutic use. Precede the complication with an ampersand since the condition requiring the drug is not reported. Refer to Section V, Part R, 1, Drugs, medicaments, biological substances causing adverse effects in therapeutic use (Y40-Y59) for coding complications of drugs during therapeutic use.

Place I (a) Acute cocaine poisoning T405 &X42

9 (b)

(c)

MOD II Cocaine use F149 T405

Accident

Ingested cocaine

Code cocaine use to F149 as listed under Dependence in Volume 3 since reported on the certificate with drug poisoning. Refer to Section V, Part Q, 2, Poisoning by drugs for instructions in coding drug poisoning.

Place I (a) Respiratory failure J969

9 (b) Acute drug use F199

(c)

MOD II &X42 T402

Accident

Overdose of morphine

Code acute drug use to F199 since reported on the certificate with drug poisoning.

Place I (a) Poisoning by drugs T509 &X44

9 (b)

(c)

II Use of sedatives F139

Code use of sedative to F139 as listed under Dependence in Volume 3 since reported on the certificate with drug poisoning.

20. Tobacco Use (F179)

Code F179 (Tobacco use)

a. When age of the decedent is greater than or equal to (>=) 1 year

AND

b. When the certifier selects “Yes” or “Probably” in the tobacco box on the US Standard Certificate of Death.

Did tobacco use contribute to death?

Yes ☐ Probably ☐

No ☐ Unknown ☐

The F179 should follow the last code in Part II.

I (a) Pneumonia J189

(b) Lung cancer C349

II COPD J449 F179

Did tobacco use contribute to death?

Yes ☒ Probably ☐

No ☐ Unknown ☐

Female, 2 months

I (a) Pneumonia J189

(b)

Did tobacco use contribute to death?

Yes ☒ Probably ☐

No ☐ Unknown ☐

No F179 is necessary for the tobacco box entry since age of decedent is less than 1 year old.

21. Psychotic Episode NOS (F239)

Code F068 (Psychotic episode, organic NEC)

When reported due to or on the same line with conditions classifiable to the following categories:

A000-E899 L88 R042-R048

F068 L920 R060-R065

G000-G98 L92-L932 R068

H600-H709 L951 R090-R091

H720-H739 L980-L981 R291

I00-J989 M000-N459 R54

K20-L109 N490-N809 R600-R609

L120-L449 N990-N992 R75

L510-L599 N994-Q999

L710-L719 R02

I (a) TIA’s with psychotic episodes G459 F068

(b) Cerebral arteriosclerosis I672

Code psychotic episode on I(a) F068, since reported on the same line with TIA (G459). It could also be coded to F068 since reported due to cerebral arteriosclerosis (I672).

22. Psychosis (any F29)

Code F09 (Psychosis, organic NEC)

When reported due to or on the same line with conditions classifiable to the following categories:

A000-E899 R75 S840-S899 T909

F09 S010-S029 S910-S929 T910

G000-G98 S040-S050 S940-S999 T911-T915

I00-J989 S052-S099 T012-T029 T918

K20-L109 S110-S129 T041-T08 T919-T922

L120-L449 S140-S199 T091 T924-T926

L510-L599 S210-S229 T093-T10 T928

L710-L719 S240-S299 T111 T929-T932

L88 S310-S328 T113-T12 T934-T936

L920 S340-S399 T131 T938

L928-L932 S410-S429 T133-T139 T939

L951 S440-S499 T141-T142 T940-T953

L980-L981 S510-S529 T144-T329 T954

M000-N459 S540-S599 T340-T349 T958-T959

N490-N809 S610-S628 T351-T889 T96-Y899

N950-N959 S640-S699 T901-T903

N990-N992 S710-S729 T904

N994-Q999 S740-S799 T905

R54 S810-S829 T908

I (a) Pneumonia J189

(b) Psychosis - cerebrovascular arteriosclerosis F09 I672

23. Dissociative Disorder (F449)

Code F065 (Organic dissociative disorder)

When reported due to conditions classifiable to the following categories:

A000-E899 L88 R042-R048

F065 L920 R060-R065

G000-G98 L928-L932 R068

H600-H709 L951 R090-R091

H720-H739 L980-L981 R291

I00-J989 M000-N459 R54

K20-L109 N490-N809 R600-R609

L120-L449 N990-N992 R75

L510-L599 N994-Q999 S000-Y899

L710-L719 R02

I (a) Dissociative disorder F065

(b) Remote subdural hematoma T905

Code I(a) organic dissociative disorder, F065, since reported due to an injury.

I (a) Dissociative disorder F065

(b) Senility R54

Code I(a) organic dissociative disorder, F065, since reported due to senility.

24. Personality Disorder (F609), Personality Change (Enduring) (F629)

Code F070 (Organic personality disorder)

When reported due to conditions classifiable to the following categories:

A000-E899 N490-N809 S440-S499 T093-T10

F070 N990-Q999 S510-S529 T111

G000-G98 R54 S540-S599 T113-T12

I00-J989 R75 S610-S628 T131

K20-L109 S010-S029 S640-S699 T133-T139

L120-L449 S040-S050 S710-S729 T141-T142

L510-L599 S052-S099 S740-S799 T144-T329

L710-L719 S110-S129 S810-S829 T340-T349

L88 S140-S199 S840-S899 T351-T889

L920 S210-S229 S910-S929 T901-T922

L928-L932 S240-S299 S940-S999 T924-T932

L951 S310-S328 T012-T029 T934-Y899

L980-L981 S340-S399 T041-T08

M000-N459 S410-S429 T091

Place I (a) Personality disorder F070

9 (b) Head injury S099

Code I(a) organic personality disorder, F070, since reported due to a head injury.

I (a) Personality disorder F070

(b) Meningioma brain D320

Code I(a) organic personality disorder, F070, since reported due to a meningioma brain.

I (a) Personality change F070

(b) Jakob-Creutzfeldt Syndrome A810

Code I(a) organic personality disorder, F070, since reported due to Jakob-Creutzfeldt Syndrome.

25. Mental Disorder (any F99)

Code F069 (Organic mental disorder)

When reported due to or on the same line with conditions classifiable to the following categories:

A000-G98 M000-N459 S000-S199 T510-T519

H600-H709 N490-N809 T019 T66-T68

H720-H739 N990-N992 T028 T698-T758

I00-J989 N994-Q999 T029 T790-T799

K20-L109 R02 T049 T900-T911

L120-L449 R042-R048 T062 T913

L510-L599 R060-R065 T064 T918-T919

L710-L719 R068 T07-T08 T940-T950

L88 R090-R091 T093-T094 T958-T959

L920 R291 T140-T149 T97

L928-L932 R54 T200-T207 T981-T982

L951 R600-R609 T340-T341 V010-Y872

L980-L981 R75 T350-T352

I (a) Cardiorespiratory arrest I469

(b) Heart failure I509

26. Parkinson Disease (G20)
Advanced Parkinson Disease (G2000)
Grave Parkinson Disease (G2000)
Severe Parkinson Disease (G2000)

a. Code G214 (Vascular parkinsonism)

When reported due to:

G214

I672-I673

I678-I679

I698

I709

I (a) Parkinsonism G214

(b) Arteriosclerosis I709

(c)

b. Code G219 (Secondary parkinsonism)

When reported due to:

A170-A179 B900 R75

A504-A539 B902 S000-T357

A810-A819 B91 T66-T876

A870-A89 B941 T900-T982

B003 B949 T983

B010 F200-F209 X50-X599

B021-B022 G000-G039 X70-X84

B051 G041-G09 X91-Y09

B060 G20-G2000 Y20-Y369

B200-B24 G218-G219 Y600-Y849

B261 G300-G309 Y850-Y872

B375 I950-I959 Y881-Y899

I (a) Parkinson disease G219

(b) Tuberculous meningitis A170

(c)

I (a) Secondary Parkinson disease G219

(b)

(c)

27. Cerebral Sclerosis (G379)

Code I672 (Cerebrovascular atherosclerosis)

a. When reported due to or on the same line with:

A500-A539 M100-M109

E000-E349 M300-M359

E660-E669 N000-N289

E700-E839 N390

E890-E899 Q600-Q619

I10-I150 Q630-Q639

I159 Q890-Q892

I672 R54

I700-I709 T383

I770 Y423

I99

b. When reported as causing:

I600-I679

I690-I698

I (a) Cerebral edema G936

(b) Cerebral sclerosis G379

I (a) Cerebral thrombosis I633

(b) Cerebral sclerosis I672

I (a) ASHD I251

(b)

(c)

II Cerebral sclerosis, hypertension 1672 I10

28. Myopathy (G729)

Code I429 (Cardiomyopathy)

When reported due to:

A150-A1690 E648-E649 R54

A178 E660-E669 R75

A181 E740 T360-T66

A188 E760-E769 T97

B332 E831 X45

B560-B575 E880-E889 X65

B948 I00-I259 Y15

D500-D649 I300-I4290 Y400-Y599

D758 I514-I5150 Y842

E100-E149 I700-I709 Y86-Y872

E40-E519 P200-P220 Y883

E639 P916

E641 R31

I (a) Myopathy I429

(b) ASHD I251

(c)

Code I(a) cardiomyopathy, I429, since reported due to a specific heart condition.

29. Brain Damage, child (G809)

Code G939 (Brain damage)

When reported due to:

A000-F199 M000-N399 R400-R402

F200-F99 N700-N889 R54

G000-G98 O000-Q999 R560-R5800

H600-H749 R02 R600-R609

H950-J80 R040-R049 R630

J82-J989 R060-R068 R75

K700-K769 R090-R092 S000-Y899

L00-L989 R291

Male, 11 years

I (a) Cardiac arrest I469

(b) Brain damage G809

Since the age of the decedent is less than 18 years of age and there is no indication of the cause of the brain damage, code G809, brain damage, child.

Male, 11 years

I (a) Brain damage G939

(b) Down syndrome Q909

Since there is an indication of the cause of the brain damage, code brain damage, G939.

30. Paralysis (any G81, G82, or G83 excluding senile paralysis)

Code the paralysis for decedent age 28 days and over to G80 (Infantile cerebral palsy) with appropriate fourth character

When reported due to:

P000-P969

Female, 3 months

I (a) Pneumonia 1wk J189

(b) Paraplegia 3 mos G808

Code the paraplegia on I(b) to infantile paraplegia, G808, since reported due to an injury of the spinal cord since birth.

31. Cataract (H269)

Code H264 (Secondary cataract)

When reported due to:

A1690 H269

B200-B24 H579

E100-E149 R54

E160-E162 R75

E711 T66

E742 Y493

E830 Y540

E835 Y576

H264

I (a) CVA I64

(b) Cataract H264

Code I(b), secondary cataract, H264, since reported due to diabetes (E149).

32. Varices NOS and Bleeding Varices NOS (I839)

Code (a) I859 (Esophageal varices) or
(b) I850 (Bleeding esophageal varices)

When reported due to or on same line with:

Alcoholic diseases classified to: F100-F109

Liver diseases classified to: B150-B199, B251, B942, K700-K769

Toxic effect of alcohol classified to: T510-T519, T97

I (a) Varices I859

(b) Cirrhosis of liver K746

I (a) Bleeding varices I850

(b) Cirrhosis of liver K746

33. Pneumoconiosis (J64)

Code J60 (Coalworker pneumoconiosis)

When Occupation is reported as:

Coal miner

Coal worker

Miner

Occupation: Coal Miner

I (a) Bronchitis J40

(b) Pneumoconiosis J60

34. Diaphragmatic Hernia in K44

Code Q790 (Congenital diaphragmatic hernia)

When reported as causing hypoplasia or dysplasia of lung NOS (Q336).

I (a) Lung dysplasia Q336

(b) Diaphragmatic hernia Q790

(c)

35. Laennec’s Cirrhosis NOS (K703)

Code K746 (Nonalcoholic Laennec’s cirrhosis)

When reported due to:

A000-B99 K710-K718 Y574-Y599

C000-D539 K730-K760 Y640

D730-D739 K761 Y86

E02-E0390 K763 Y870-Y872

E100-E149 K768-K851 Y880

E500-E519 K853-K859 Y881

E52 K861-K909

E530-E849 Q410-Q459Q900-Q999

F110-F169 R75

F180-F199 T360-T509

I050-I099 T520-T659

I110-I119 T97

I130-I4250 X40-X44

I427-I519 X46-X49

I81 Y400-Y572

K500-K519 Y573

K630-K639

I (a) Cardiac arrest I469

(b) Laennec’s cirrhosis K746

Code I(b) nonalcoholic Laennec’s cirrhosis since reported “due to” diabetes

36. Biliary Cirrhosis NOS (K745)

Code K744 (Secondary biliary cirrhosis)

When reported due to:

A000-B99 K763

C000-D539 K768-K909

D730-D739 Q410-Q459

E02-E0390 Q900-Q999

E100-E149 R75

E500-E849 R780

F100-F169 R826

F180-F199 R893

I050-I099 T360-T659

I110-I119 T97

I130-I519 X40-X49

I81 X65

K500-K519 Y15

K630-K639 Y400-Y599

K700-K718 Y640

K730-K760 Y86-Y880

K761 Y881

I (a) Biliary cirrhosis K745

(b)

(c)

I (a) Primary biliary cirrhosis K743

(b)

(c)

I (a) Secondary biliary cirrhosis K744

(b)

(c)

I (a) Biliary cirrhosis K744

(b) Carcinoma pancreas C259

(c)

37. Lupus Erythematosus (L930), Lupus (L930)

Code M321 (Systemic lupus erythematosus with organ or system involvement)

When reported as causing a disease of the following systems:

Anemia

Circulatory (including cardiovascular,

lymph nodes, spleen)

Gastrointestinal

Musculoskeletal

Respiratory

Thrombocytopenia

Urinary

I (a) Nephritis N059

(b) Lupus erythematosus M321

(c)

38. Gout (M109)

Code M104 (Secondary gout)

When reported due to:

B200-B24 L578-L589

C880-C959 L930-L932

D45 L945

D550-D599 L951

D751 L981

D758 M100-M109

E168 R75

E740 T510-T519

F100-F102 T97

F109 X45

K700-K769 X65

L100-L109 Y15

L120-L449 Y86-Y872

L510-L569

I (a) Perforated gastric ulcer K255

(b) Gout M104

39. Polyarthrosis (M159)

Code M153 (Secondary multiple arthrosis)

When reported due to:

A399

B200-B24

E660-E669

G810-G839

M150-M1990

N924

N950-N959

R54

R75

S000-T983

I (a) Hypostatic pneumonia J182

(b) Polyarthrosis M153

Code I(b) secondary multiple arthrosis, M153, since reported due to obesity.

40. Coxarthrosis (M169)

Code (a) M166 (Coxarthrosis, secondary, bilateral):
(b) M167 (Coxarthrosis, secondary, NEC, (unilateral))

When reported due to:

A399

B200-B24

E660-E669

G810-G839

M150-M161

M166-M1990

N924

N950-N959

R54

R75

I (a) Pneumonia J189

(b) Debility R53

(d) Polyarthrosis M159

Code I(c) secondary coxarthrosis, M167, since reported due to polyarthrosis (M159).

41. Gonarthrosis (M179)

Code (a) M174 (Secondary gonarthrosis, bilateral):
(b) M175 (Secondary gonarthrosis, (unilateral))

When reported due to:

A399

B200-B24

E660-E669

G810-G839

M150-M171

M174-M1990

N924

N950-N959

R54

R75

I (a) Pneumonia, gonarthrosis J189 M175

(b) Hemiplegia G819

Code I(a) secondary gonarthrosis, M175, since reported due to hemiplegia.

42. Arthrosis (M199)

Code M192 (Secondary arthrosis)

When reported due to:

A399

B200-B24

E660-E669

G810-G839

M150-M190

M192-M1990

N924

N950-N959

R54

R75

I (a) Pathological fractures M844

(b) Arthrosis M192

Code I(b) secondary arthrosis, M192, since reported due to senility.

43. Kyphosis (M402)

Code M401 (Secondary kyphosis)

When reported due to:

A1690 E890-E899 M359-M489

A180 G110-G119 M800-M949

B902 G20-G2000 M960-M969

B91 G35-G379 Q050-Q059

C400-C419 G540-G549 Q760-Q799

C490-C499 G600-G839 Q850

C795 G950-G959 Q870-Q878

D166 G970-G979 Q893-Q999

D480 M000-M120 S000-Y899

E200-E215 M150-M1990

E550-E559 M320-M351

I (a) COPD J449

(b) Kyphosis M401

Code I(b) secondary kyphosis, M401, since reported due to spinal osteoarthritis.

44. Scoliosis (M419)

a. Code M414 (Neuromuscular scoliosis)

When reported due to:

A800-A809 G700-G709

B91 G800-G809

G111 M414

I (a) Respiratory failure J969

(b) Severe scoliosis years M414

Code I(b) neuromuscular scoliosis, M414, since reported due to polio (B91).

b. Code M415 (secondary scoliosis)

When reported due to:

A1690 G09 M415-M489

A180 G20-G2000 M800-M949

B902 G360-G379 M960-M969

C400-C419 G540-G549 Q050-Q059

C490-C499 G600-G64 Q760-Q799

C795 G950-G959 Q850

D166 G970-G979 Q870-Q878

D480 M000-M120 Q893-Q999

E200-E215 M150-M1990 S000-Y899

E550-E559 M320-M351

E890-E899 M359-M413

I (a) Pneumonia J189

(b) Scoliosis M415

Code I(b) secondary scoliosis, M415, since reported due to progressive systemic sclerosis.

45. Osteonecrosis (M879) )

Code M873 (Secondary osteonecrosis)

When reported due to:

A000-A399 D550-D589 M860-M870

A400-A419 H650-H669 M873

A420-B889 J00-J399 M878-M889

B89 L00-L089 M894

B900-B949 M000-M1990 M910-M939

B99 M320-M351 N340-N343

C400-C419 M359 N390

C763 M420-M429 N700-N768

C795 M45-M461 R75

C810-C969 M462

D160-D169 M463-M479

D480 M600

I (a) Septicemia A419

(b) Osteonecrosis hip M873

Code I(b) secondary osteonecrosis, M873, since reported due to infective myositis (M600).

46. Dysmenorrhea (N946)

Code N945 (Secondary dysmenorrhea)

When reported due to:

C530-C55 N800-N809

C798 N840-N841

D060-D069 N850-N889

D073 N945

D250-D269 Q510-Q519

D390 Q528

N710-N739

I (a) Anemia and gastric ulcer D649 K259

(b) Menorrhagia with dysmenorrhea N920 N945

Code I(b) secondary dysmenorrhea, N945, since reported due to cancer of endocervix (C530).

47. Cesarean Delivery for Inertia Uterus (O622)

Hypotonic Labor (O622)

Hypotonic Uterus Dysfunction (O622)

Inadequate Uterus Contraction (O622)

Uterine Inertia During Labor (O622)

Code O621 (Secondary uterine inertia)

When reported due to:

O100-O209 O440-O469

O230-O249 O621

O260-O264 O670-O679

O266-O269 O95

O310 O980-O998

O330-O349

I (a) Cardiac arrest O754

(b) Uterine inertia O621

Code I(b) secondary uterine inertia, O621, since reported due to diabetes mellitus of pregnancy (O249).

48. Brain Damage, newborn (P112)

Code P219 (Anoxic brain damage, newborn)

When reported due to:

A000-P029

P040-P082

P132-P158

P200-R825

R826

R827-R892

R893

R894-R961

R98

Male, 9 hours

I (a) Brain damage P219

(b) Congenital heart disease Q249

Code I(a) anoxic brain damage, P219, since reported due to congenital heart disease.

49. Intracranial Nontraumatic Hemorrhage of Fetus and Newborn (P52)

Code P10 (Intracranial laceration and hemorrhage due to birth injury) with the appropriate fourth character

When reported due to:

P030-P039

P100-P112

P119

P130-P131

P159

Male, 9 hours

I (a) Cerebral hemorrhage P101

(b) Fractured skull during birth P130

(c)

Code I(a) cerebral hemorrhage due to birth injury, P101, since reported due to a fracture skull occurring during birth.

Female, 2 weeks

I (a) Cerebral hemorrhage P101

(b) Birth injury P159

(c)

Code I(a) cerebral hemorrhage due to birth injury, P101.

50. Septal Defect, (atrial), (auricular), (heart), (ventricular), (Q210, Q211, Q212, Q219)

Code I510 (Acquired septal defect) providing there is no indication the defect is congenital

a. When reported due to:

A000-A099 I400-I519 N990-N999 R502-R509

A181 I700-J80 P000-P049 R53-R54

A200-B89 J82-J989 P100-Q079 R560-R609

B908-E899 K20-K929 Q240-Q249 R634-R635

F100-F199 L890-L899 Q260-Q349 R64

G000-G419 L97 Q380-Q459 R688-R799

G450-G459 L984 Q600-Q799 R826

G500-G729 M000-M1990 Q850-R098 R893

G900-G98 M300-M549 R11 S000-Y899

H650-H839 M800-M959 R160-R18

I00-I029 N000-N399 R222

I10-I339 N600-N96 R300-R398

b. When reported on the same line with:

I110-I119

I130-I139

I200-I339

I400-I519

I (a) Cardiac arrest I469

(b) Ventricular septal defect I510

51. Hypoplasia or Dysplasia of Lung NOS (Q336)

Code P280 (Primary atelectasis of newborn)

When reported anywhere on the record with the following codes and not reported due to diaphragmatic hernia in K44.

A500-A509

B200-B24

P000-P009

P011-P013

P050-P073

P220-P229

P280

P350-P399

P612

Q600-Q611

Q613-Q649

R75

I (a) Hypoplasia lung P280

(b)

(c)

II Prematurity P073

Female, 5 hrs.

I (a) Dysplasia of lung 5 hrs Q336

(b)

(c)

II Hyaline membrane disease P220

Code Q336, since the duration and age are the same indicating the condition was congenital.

52. Injury (S000-T149)

Code P10-P15 (Birth trauma)

a. When the age of decedent is less than 28 days

AND

b. There is no mention of external cause

AND

c. Reported due to a condition in P000-P969

Male, 5 days

I (a) Femur fracture P132

(b) Breech delivery P030

Code femur fracture as indexed under Birth, injury, fracture, femur.

53. Fracture (any site) (T142)

Code M844 (Pathological fracture)

a. When reported due to:

A180 D160-D169 M320-M351 M854-M879 Q799

A500-A509 D480 M359 M893-M895 T810-T819

A521 D489 M420-M429 M898-M939 T840-T849

A527-A539 E210-E215 M45-M519 M941-M949 T870-T889

A666 E550-E559 M600 M960

C000-C399 E896-E899 M843-M851 M966-M969

C430-C794 G120-G129 Q770-Q789

C796-C97 M000-M1990

b. When reported due to or on the same line with:

C40-C41 M80-M81 M88

C795 M83

NOTE 1: If accident box is checked, do not enter an external cause code.

NOTE 2: If a fracture qualifies as pathological, all fractures reported of the same site will be coded pathological as well.

NOTE 3: If there is clear evidence that the fracture was a result of trauma instead of a disease, then code fracture as traumatic not pathological.

I (a) Fracture hip M844

(b) Osteoarthritis M199

I (a) Myocardial infarction I219

(b) ASHD I251

(c)

II Fracture of spine due to M844 M139 W19

arthritis causing fall

I (a) Pneumonia J189

(b) Osteoporosis fracture spine M819 M844

I (a) Pneumonitis J189

(b) Arteriosclerosis I709

Accident

Spontaneous in bed

Code fracture of femur as pathological, M844, since the certifier indicated it was spontaneous. Do not enter code for “accident” in checkbox.

I (a) Aspiration pneumonia J690

(b) Left hip fracture M844

(c)

II Hip fracture, anemia, osteoporosis M844 D649 M819

Code the hip fracture on (b) and in Part II as pathological, applying instruction b and note 2.

Place I (a) Generalized medical deconditioning R53

9 II Depression, alcohol abuse, osteoporosis, spinal fx F329 F101 M819 T08 &W18

MOD due to blunt impact (fall)

Accident

Fall from standing

Code fracture of spine as traumatic since it is directly due to the fall even though osteoporosis is on the record.

54. Starvation NOS (T730)

Code E46 (Malnutrition NOS)

When reported due to:

A000-E649 L100-L129 R13 T058

E670-F509 L400-L409 R54 T065-T08

F530-F539 L510-L539 R600-R609 T091-T099

F608-F609 L890-L899 R630 T141

F680-F73 L97 R633-R634 T148-T149

F920 L984 R75 T170-T217

F982-F983 M000-M1990 S010-S099 T270-T329

F989-G98 M300-N459 S110-S199 T360-T659

I00-J80 N700-N768 S210-S299 T800-T889

J82-J989 O000-Q079 S310-S399 T97

K020-K029 Q200-Q824 T019-T021 T983

K040-K069 Q850-Q999 T029 V010-X52

K080-K929 R11 T041 X54-Y05

Y070-Y899

I (a) Anemia D649

(b) Starvation E46

Code I(b) E46, malnutrition, since reported due to a neoplasm.

I (a) Starvation E46

(b) Crushed abdomen S381

II Auto accident &V499

Code I(a) E46, malnutrition, since reported due to an internal injury.

55. Compartment Syndrome (T796)

Code M622 (Nontraumatic compartment syndrome)

When reported due to:

A530-A539 F109 N040-N049

B200-B24 F449 N170-N19

B91 G10-G419 Q000-Q079

C000-D489 G450-G98 Q250-Q269

D610-D699 I250-I259 Q650-Q799

E000-E039 I48 Q900-Q999

E230-E237 I600-I99 R190

E40-E46 K310-K389 R198

E511-E52 K560-K567 R263

E630-E649 K590-K599 R402

E750-E752 K650-K659 R58-R5800

E754 K850-K869 R75

E872 K910-K919

E890-E899 L890-L899

F100-F102 L97-M999

I (a) Compartment syndrome M622

(b) Hemorrhagic pancreatitis K859

Code I(a) M622 since reported due to pancreatitis.

SECTION IV - CLASSIFICATION OF CERTAIN ICD CATEGORIES

General information

Separate categories are provided in ICD-10 for coding malignant primary and secondary neoplasms (C00-C96), carcinoma in situ (D00-D09), benign neoplasms (D10-D36), and neoplasms of uncertain or unknown behavior (D37-D48). Categories and subcategories within these groups identify sites and/or morphological types.

Morphology describes the difference in type and structure of cells or tissues (histology) as seen under the microscope and behavior. The ICD classification of neoplasms consists of several major morphological groups (types) of neoplasms including the following:

Carcinomas including squamous cell carcinoma and adenocarcinoma

Sarcomas and other soft tissue tumors including mesotheliomas

Lymphomas including Hodgkin lymphoma and non-Hodgkin lymphoma

Site specific types (types that indicate the site of the primary neoplasm)

Leukemias

Other specified morphological groups

The morphological types of neoplasms are listed in ICD-10 following Chapter XX in Volume 1 and also appear in Volume 3. Morphology, behavior, and site must all be considered when coding neoplasms. This may take the form of a reference to the appropriate column in the “Neoplasm” listing in the Index when the morphological type could occur in several organs. For example:

Adenoma, villous (M8261/1) - see Neoplasm, uncertain behavior

Or to a particular part of that listing when the morphological type originates in a particular type of tissue. For example:

Fibromyxoma (M8811/0) - see Neoplasm, connective tissue, benign

The Index may give the code for the site assumed to be most likely when no site is reported for a morphological type. For example:

Adenocarcinoma

- pseudomucinous (M8470/3)

- - specified site - see Neoplasm, malignant

- - unspecified site C56

Or the Index may give a code to be used regardless of the reported site when the vast majority of neoplasms of that particular morphological type occur in a particular site. For example:

Nephroma (M8960/3) C64

Always look up the morphological description in the Index before referring to the listing under “Neoplasm” for the site.

The morphological code numbers consist of five characters: the first four identify the histological type of the neoplasm and the fifth, following a slash, indicates its behavior. These morphological codes (M codes) are not used by NCHS for coding purposes.

The behavior of a neoplasm is an indication of how it will act. The following terms describe the behavior of neoplasms:

Malignant, primary site (capable of rapid growth C00-C76,
and of spreading to nearby and distant sites) C80-C96

Malignant secondary (spread from another C77-C79
site; metastases)

In-situ (confined to one site) D00-D09

Benign (non-malignant) D10-D36

Uncertain or unknown behavior (undetermined D37-D48
whether benign or malignant)

Unless it is specifically indexed, code a morphological term ending in “osis” in the same way as the tumor name to which “osis” has been added is coded. For example, code neuroblastomatosis in the same way as neuroblastoma. However, do not code hemangiomatosis that is specifically indexed to a different category in the same way as hemangioma.

All combinations of the order of prefixes in compound morphological terms are not indexed. For example, the term “chondrofibrosarcoma” does not appear in the Index, but “fibrochondrosarcoma” does. Since the two terms have the same prefixes (in a different order), code the chondrofibrosarcoma the same as fibrochondrosarcoma.

A. Malignant neoplasms (C00-C96)

The categories that have been provided for the classification of malignant neoplasms distinguish between those that are stated or presumed to be primary (originate in) of the particular site or types of tissue involved, those that are stated or presumed to be secondary (deposits, metastases, or spread from a primary elsewhere) of specified sites, and malignant neoplasms without specification of site. These categories are the following:

C00-C75 Malignant neoplasms, stated or presumed to be primary, of specified sites and different types of tissue, except lymphoid, hematopoietic, and related tissue

C76 Malignant neoplasms of other and ill-defined sites

C77-C79 Malignant secondary neoplasm, stated or presumed to be spread from another site, metastases of sites, regardless of morphological type of neoplasm

C80 Malignant neoplasm of unspecified site (primary) (secondary)

C81-C96 Malignant neoplasms, stated or presumed to be primary, of lymphoid, hematopoietic, and related tissue

In order to determine the appropriate code for each reported neoplasm, a number of factors must be taken into account including the morphological type of neoplasm and qualifying terms. Assign all malignant neoplasms to the appropriate category for the morphological type of neoplasm, i.e., to the code shown in the Index for the reported term. Morphological types of neoplasm include categories C40-C41, C43, C44, C45, C46, C47, C49, C70-C72, and C80. Specific morphological types include:

C40-C41 Malignant neoplasm of bone and articular cartilage of other and unspecified sites

Osteosarcoma

Osteochondrosarcoma

Osteofibrosarcoma

Any neoplasm cross-referenced as “See also Neoplasm bone, malignant”

I (a) Osteosarcoma of leg C402

Code the morphological type “Osteosarcoma” to Neoplasm, malignant, bone of the specified site as cross-referenced.

C43 Malignant melanoma of skin

Melanosarcoma

Melanoblastoma

Any neoplasm cross-referenced as “See also Melanoma”

I (a) Melanoma of arm C436

Based on the note in the Index, code melanoma of arm as indexed under Melanoma, site classification.

I (a) Melanoma of stomach C169

Melanoma of stomach is not found under Melanoma in the Index. The term should be coded by site under Neoplasm, malignant.

C44 Other malignant neoplasm of skin

Basal cell carcinoma

Sebaceous cell carcinoma

Any neoplasm cross-referenced as “See also Neoplasm skin, malignant”

I (a) Sebaceous cell carcinoma nose C443

Code the morphological type “Sebaceous cell carcinoma” to Neoplasm, malignant, skin of the specified site as cross-referenced.

C49 Malignant neoplasm of other connective and soft tissue

Liposarcoma

Rhabdomyosarcoma

Any neoplasm cross-referenced as “See also Neoplasm, connective tissue, malignant”

I (a) Rhabdomyosarcoma abdomen C494

Code the morphological type “Rhabdomyosarcoma” to Neoplasm, malignant, connective tissue of the specified site as cross-referenced.

I (a) Sarcoma pancreas C259

Code the morphological type “Sarcoma” to Neoplasm, malignant, connective tissue of the specified site as cross-referenced. Refer to the “Note” under Neoplasm, malignant, connective tissue concerning sites that do not appear in this list.

C80 Malignant neoplasm without specification of site

Cancer

Carcinoma

Malignancy

Malignant tumor or neoplasm

Any neoplasm cross-referenced as “See also Neoplasm, malignant”

I (a) Carcinoma of stomach C169

Code the morphological type “Carcinoma” to Neoplasm, malignant, stomach as indexed.

I (a) Cancer prostate C61

Code the morphological type “Cancer” to Neoplasm, malignant, prostate as indexed.

I (a) Adenosarcoma breast C509

Code the morphological type “Adenosarcoma” to Neoplasm, malignant, of the specified site as cross-referenced.

C81-C96 Malignant neoplasms of lymphoid, hematopoietic, and related tissue

Leukemia

Lymphoma

I (a) Lymphoma of brain C859

Code Lymphoma NOS, C859, as indexed. Neoplasms in C81-C96 are coded by morphological type and not by site.

1. Neoplasms stated to be secondary

Categories C77-C79 include secondary neoplasms of specified sites regardless of the morphological type of the neoplasm. The Index contains a listing of secondary neoplasms of specified sites under “Neoplasm.” Secondary neoplasms of specified sites without indication of the primary site require an additional code to identify the morphological type of neoplasm if the morphological type is classifiable to one of the following categories: C40, C41, C43, C44, C45, C46, C49, C70, C71, and C72.

I (a) Secondary melanoma of lung C439 C780

Melanoma is classified to C43; therefore, when stated secondary of a site, code Melanoma, unspecified site and secondary neoplasm of the reported site.

I (a) Secondary carcinoma of intestine C785

The morphological type of the term “carcinoma” is C80; therefore, code a secondary neoplasm code only.

2. Malignant neoplasms with primary site indicated

NOTE: If two or more malignant neoplasms are indicated as primary, refer to instructions under 5. Independent (primary) sites.

a. If a particular site is indicated as primary, it should be coded as primary whether in Part I or Part II. The primary site may be indicated in one of the following ways:

(1) If two or more sites with the same morphology are reported, and one site is specified as primary in either Part I or II, code as primary and code other neoplasms secondary.

I (a) Carcinoma of bladder C791

II Primary in kidney C64

Code carcinoma of bladder as secondary and code primary malignant neoplasm of kidney.

I (a) Primary of kidney C64

II Carcinoma of bladder C791

Code carcinoma of bladder as secondary and code primary malignant neoplasm of kidney.

I (a) Primary cancer of lung C349

(b) Cancer of breast C798

Code primary malignant neoplasm of lung and code cancer of breast as secondary.

NOTE: This also applies when the same site is reported more than once and qualified as primary

I (a) Met lung cancer C780

(b) Primary lung cancer C349

Code metastatic lung cancer on I(a) as secondary and code primary malignant cancer of lung on I(b).

(2) The specification of other sites as “secondary,” “metastases,” “metastasis,” “spread,” or a statement of “metastasis NOS” or “metastases NOS”

I (a) Carcinoma of breast C509

(b) Secondaries in brain C793

Code I(a) primary malignant neoplasm of breast, and I(b) to secondary malignant neoplasm of brain.

I (a) Stomach metastases C788

(b) Lung cancer C349

Code I(a) secondary neoplasm of stomach and I(b) primary malignant neoplasm of lung.

I (a) Brain metastases C793

(b) Liver cancer C229

Code I(a) secondary neoplasm of brain and I(b) primary malignant neoplasm of liver.

I (a) Lung cancer with metastases C349 C80

Code I(a) primary cancer of lung followed by the NOS code for metastases.

I (a) Bladder cancer with metastases C679 C782 C780

(b) of pleura and lung

II History of breast cancer C509

Code I(a) primary malignant neoplasm of bladder, and secondary neoplasm of pleura and lung. Code Part II to primary malignant neoplasm of breast.

(3) Morphology indicates a primary malignant neoplasm

If a morphological type implies a primary site, such as hepatoma, code as primary.

I (a) Hepatoma C220

Code hepatoma as a primary neoplasm.

I (a) Carcinoma C80

(b) Pseudomucinous C56

adenocarcinoma

Code I(a) Carcinoma as neoplasm malignant, unspecified site. Code I(b) to primary malignant neoplasm of ovary, since pseudomucinous adenocarcinoma of unspecified site is assigned to the ovary in the Index.

b. If a morphological type of malignant neoplasm indicating primary is reported in Part I or Part II with a different morphological type of malignant neoplasm that is stated primary, consider both neoplasms to be primary.

I (a) Sarcoma of thigh C492

II Primary liver carcinoma C229

Code each neoplasm as indexed. Both I(a) Sarcoma of thigh and Part II Primary liver carcinoma are primary malignant neoplasms.

3. Site specific neoplasms

a. Certain neoplasms are classified or indexed directly to a specific site. Classify morphological types of neoplasms that appear in the Index with specific codes (site specific neoplasms) e.g. “Hepatocarcinoma (M8170/3) C220,” as indexed.

I (a) Renal cell carcinoma C64

Code renal cell carcinoma as indexed.

b. If there is a conflict between the code for a site specific neoplasm and the stated site, code the site specific neoplasm as indexed and code the stated site as secondary. Enter the code for the secondary neoplasm on the same line with and immediately following the code for the site specific neoplasm.

I (a) Hepatocarcinoma of brain C220 C793

Code hepatocarcinoma as indexed and code secondary malignant neoplasm of brain as the second entry on I(a).

c. When a site specific neoplasm is reported due to the same site specific neoplasm, code each as indexed.

I (a) Bronchogenic carcinoma C349

(b) Bronchogenic carcinoma C349

Code I(a) and I(b) to bronchogenic carcinoma, as indexed.

d. If the only thing reported is a site specific neoplasm and a malignant neoplasm of the same site, with or without metastases, code both as primary.

I (a) Hepatocellular cancer C220

(b) Liver cancer C229

Code both the hepatocellular cancer and liver cancer as primary.

I (a) Oat cell cancer C349

(b) Lung cancer C349

Code both the oat cell cancer and lung cancer as primary.

I (a) Liver cancer and hepatocellular carcinoma with mets C229 C220 C80

Code both the liver cancer and hepatocellular carcinoma as primary. Code metastases to NOS as indexed.

4. Other morphological types of neoplasms

If adenocarcinoma, cancer, carcinoma, neoplasm (malignant) or tumor (malignant) of a site, except neoplasms classifiable to C81-C96, are reported due to a morphological type of neoplasm of unspecified site, code the neoplasm on the upper line qualified by the morphological type, and do not enter a code for the morphological type of unspecified site on the lower line if:

a. The morphological type of neoplasm reported on the lower line is C80.

I (a) Tumor of upper lung C341

(b) Carcinoma

Code the tumor on I(a) modified by the morphological type (C80) on I(b). Leave line I(b) blank.

I (a) Cancer of bladder C679

(b) Papillary carcinoma

Code the cancer on I(a) modified by the morphological type (C80) on I(b). Leave line I(b) blank.

b. The morphological type of neoplasm of unspecified site on the lower line is classified to the same site as the neoplasm on the upper line.

I (a) Cancer of brain C719

(b) Astrocytoma

Code the specified site on I(a) modified by the morphological type of unspecified site on I(b) since they are classified to the same site. Leave I(b) blank.

I (a) Adenocarcinoma of stomach C169

(b) Linitis plastica

Code the specified site on I(a) modified by the morphological type of unspecified site on I(b) since they are classified to the same site. Leave I(b) blank.

c. The morphological type of neoplasm of unspecified site on the lower line is classified according to the site affected, e.g., the malignant neoplasms classifiable to the following categories: C40, C41, C43, C44, C47, C49, C70, C71, and C72. Code the neoplasm on the upper line qualified by the morphological type on the lower line, and do not enter a code for the morphological type of unspecified site on the lower line.

I (a) Adenocarcinoma of face C433

(b) Melanoma

Code melanoma of face on I(a) and leave I(b) blank.

I (a) Carcinoma of leg C492

(b) Fibroliposarcoma

Code fibroliposarcoma of leg on I(a) and leave I(b) blank.

5. Independent (primary) sites

The presence of more than one primary neoplasm could be indicated in one of the following ways:

• mention of two different anatomical sites

• or two distinct morphological types (e.g., hypernephroma and intraductal carcinoma)

• or by a mix of a morphological type that implies a specific site, plus a second site.

It is highly unlikely that one primary would be due to another primary malignant neoplasm except for a group of malignant neoplasms of lymphoid, hematopoietic, and related tissue (C81-C96), within which, one form of malignancy may terminate in another (e.g., leukemia may follow non-Hodgkin lymphoma).

a. If two or more sites are mentioned in Part I and there is no indication that either site is primary or secondary, code each site as indexed.

I (a) Cancer of stomach 3 months C169

(b) Cancer of breast 1 year C509

Code to primary malignant neoplasm of each site mentioned, since it is unlikely that one primary malignant neoplasm would be due to another.

I (a) Carcinoma of colon and rectum C189 C20

Code both sites as primary and enter both on I(a).

b. If two or more morphological types of malignant neoplasm occur, one reported due to the other or reported anywhere on the record, code each as indexed.

I (a) Lymphosarcoma of mesentery C850

II Adenocarcinoma of cecum C180

Code each as though the other had not been reported since there are two different morphological types of malignant neoplasms.

I (a) Cancer of esophagus C159

(b) Hodgkin sarcoma C817

Code the cancer of the esophagus as primary and code the Hodgkin sarcoma as indexed. They are different morphological types.

I (a) Leukemia C959

II Carcinoma of breast C509

Code each neoplasm as indexed. Two different morphological types are mentioned.

c. If two or more morphological types of malignant neoplasm occur in lymphoid, hematopoietic, or related tissue (C81-C96), code each as indexed. When acute exacerbation of, or blastic crisis (acute) in, chronic leukemia is reported, code both the acute form and chronic form. If stated acute and chronic, code both as indexed.

I (a) Acute lymphocytic leukemia C910

(b) Non-Hodgkin lymphoma C859

Code each as indexed since both are morphological types classified within the categories C81-C96.

I (a) Chronic lymphocytic C911 C910

leukemia with blastic crisis

Code both chronic lymphocytic leukemia and acute lymphocytic leukemia.

I (a) Acute exacerbation of chronic C910 C911

(b) lymphocytic leukemia

Code to the acute and chronic form when reported as acute exacerbation of a chronic form of leukemia and code both on the same line.

d. Do not use a neoplasm in a due to position to determine secondary and primary.

I (a) Carcinoma of head of pancreas C250

(b) Carcinoma of tail of pancreas C252

Code primary malignant neoplasm of head of pancreas for I(a) and code primary malignant neoplasm of tail of pancreas for I(b).

I (a) Cancer of stomach C169

(b) Cancer of gallbladder C23

Code each site primary.

I (a) Cancer of breast C509

(b) Cancer of endometrium C541

Code each site primary.

6. Metastases

Metastases is the spread of a primary malignant neoplasm to another site; therefore, metastases of a site is always secondary.

a. When malignancy NOS or any morphological type classifiable to C80 is reported with metastases of a site on a line, code C80 and the secondary neoplasm.

I (a) Malignancy with metastases C80 C791

of bladder

Code malignancy as first entry on I(a) and code secondary bladder neoplasm as the second neoplasm on I(a).

b. Although malignant cells can metastasize anywhere in the body, certain sites are more common than others and must be treated differently. If one of the common sites of metastases (excluding lung) is qualified by the word “metastatic,” it should be coded as secondary (see other neoplasm instructions). However, if one of these sites appears alone on a death certificate and is not qualified by the word “metastatic,” it should be considered primary.

Common sites of metastases:

Bone Lymph nodes

Brain Mediastinum

Central nervous system Meninges

Diaphragm Peritoneum

Heart Pleura

Liver Retroperitoneum

Lung Spinal cord

Ill-defined sites (sites classifiable to C76)

I (a) Cancer of brain C719

Code primary cancer of brain since it is reported alone on the certificate.

• (1) Special Instruction: Lung

The lung poses special problems in that it is a common site for both metastases and primary malignant neoplasms.

• Lung should be considered as a common site of metastases whenever it appears in Part I with sites not on this list.

• If lung is mentioned anywhere on the certificate and the only other sites are on the list of common sites of metastases, consider lung primary.

• However, when the bronchus or bronchogenic cancer is mentioned, this neoplasm should be considered primary.

I (a) Carcinoma of lung C349

Code primary malignant neoplasm of lung since it is reported alone on the certificate.

I (a) Cancer of bone C795

(b) Carcinoma of lung C349

Code primary malignant neoplasm of lung on I(b) since bone is on the list of common sites of metastases and lung can, therefore, be assumed to be primary.

I (a) Carcinoma of bronchus C349

(b) Carcinoma of breast C509

Code primary malignant neoplasm of bronchus on I(a) and primary malignant neoplasm of breast on I(b). Do not code I(a) as secondary malignant neoplasm, because bronchus is excluded from the list of common sites.

I (a) Malignant neoplasm of bronchus and lung C349 C780

Code primary malignant neoplasm of bronchus and secondary malignant neoplasm of lung.

• (2) Special Instruction: Lymph Node

Malignant neoplasm of lymph nodes not specified as primary should be assumed to be secondary.

I (a) Cancer of cervical lymph nodes C770

Code secondary malignant neoplasm of cervical lymph nodes.

7. Multiple sites

a. If all sites reported (anywhere on certificate) are on the list of common sites of metastases, code to secondary neoplasm of each site of the morphological type involved, unless lung is mentioned, in which case code to (C349) primary malignant neoplasm of lung. If, however, both sites are the same, do not consider as multiple sites and code each as primary.

I (a) Cancer of liver C787

(b) Cancer of abdomen C798

Code to secondary neoplasm of both sites since both are on the list of common sites of metastases. Abdomen is one of the ill-defined sites included in the C76.- category.

I (a) Malignant carcinoma of pleura C782 C781

and mediastinum

Code secondary malignant neoplasm of pleura and secondary malignant neoplasm of mediastinum on I(a).

I (a) Peritoneal carcinoma C786

II Liver carcinoma C787

Code secondary malignant neoplasm of peritoneum on I(a) and secondary malignant neoplasm of liver in Part II.

I (a) Cancer of brain C793

(b) Cancer of lung C349

Code I(a) secondary cancer of brain since brain is on the list of common sites. Code I(b) primary cancer of lung because the only other site mentioned is on the list of common sites.

I (a) End stage cancer of liver C229

(b) Cancer of liver C229

Code I(a) and I(b) as primary cancer of liver since both sites are the same.

b. If one or more of the common sites of metastases, excluding lung, is reported and one or more site(s) or one or more morphological type(s) is mentioned on the certificate, none specified as primary, code the common site(s) secondary and the other site(s) or morphological type(s) primary.

I (a) Cancer of stomach C169

(b) Cancer of liver C787

Code I(a) primary cancer of stomach and code I(b) secondary cancer of liver since liver is on the list of common sites and stomach is not.

I (a) Liver cancer C787

(b) Bladder cancer C679

Code I(a) secondary neoplasm of liver since liver is on the list of common sites of metastases. Code I(b) and I(c) as primary.

I (a) Peritoneal cancer C786

II Mammary carcinoma C509

Code I(a) secondary peritoneal cancer since peritoneum is on the list of common sites. Code Part II primary carcinoma of breast.

I (a) Brain carcinoma C793

II Melanoma of scalp C434

Code I(a) secondary brain carcinoma since brain is on the list of common sites. Code Part II melanoma of scalp.

NOTE: If a malignant neoplasm of lymphatic, hematopoietic, or related tissue (C81-C96) is reported in one part and one of the common sites is mentioned in the other part, code the common site primary.

I (a) Brain cancer C793

(b) Lymphoma C859

Code I(a) secondary brain cancer since brain is on the list of common sites and is reported in the same part with a neoplasm indexed to C859.

I (a) Brain cancer C719

II Lymphoma C859

Code I(a) primary brain cancer. Brain is on the list of common sites of metastases, but it is reported in one part and a neoplasm indexed to C859 is reported in the other part.

c. If lung is mentioned in the same part with another site(s), not on the list of common sites, or one or more morphological type(s), code the lung as secondary and the other site(s) primary.

I (a) Lung cancer C780

(b) Stomach cancer C169

Code secondary lung cancer on I(a) and code primary stomach cancer on I(b) since both are in the same part.

I (a) Lung cancer C780

(b) Leukemia C959

Code secondary lung cancer on I(a) and code leukemia on I(b) since both are in the same part.

I (a) Bladder carcinoma C679

II Lung cancer, breast cancer C780 C509

Code I(a) primary bladder carcinoma and code primary breast cancer in Part II. Code secondary lung cancer in Part II. Lung is in the same part with another site.

d. If lung is mentioned in one part, and one or more site(s), not on the list of common sites, or one or more morphological type(s) is mentioned in the other part, code the lung as primary and the other site(s) or other morphological type primary.

I (a) Stomach cancer C169

II Lung cancer C349

Code primary stomach cancer on I(a) and code primary lung cancer in Part II. Lung is mentioned in one part and the other site is mentioned in the other part.

I (a) Leukemia C959

II Lung cancer C349

Code leukemia on I(a) and code primary lung cancer in Part II. Lung is mentioned in one part and the other morphological type is mentioned in the other part.

8. Metastatic neoplasms

The adjective “metastatic” is used in two ways-sometimes meaning a secondary neoplasm from a primary elsewhere and sometimes denoting a primary that has given rise to metastases. Neoplasms qualified as metastatic are always malignant, either primary or secondary. In order to avoid confusion, use the following to determine whether to code a metastatic neoplasm as primary or secondary.

a. Malignant neoplasm described as “from” or “metastatic from” a specified site should be interpreted as primary of that site and all other sites should be coded as secondary unless stated as primary whether in Part I or Part II.

I (a) Metastatic teratoma from ovary C80

(b) C56

Interpret as: I (a) Metastatic teratoma

(b) Primary ovary cancer

Then, code I(b) to primary malignant neoplasm of ovary since it states metastatic from ovary. Code I(a) to C80, malignant neoplasm, unspecified site.

I (a) Metastatic cancer from kidney C80

(b) C64

Interpret as: I (a) Metastatic cancer
(b) Primary kidney cancer

Then, code I(b) to primary malignant neoplasm of kidney since it states metastatic from kidney. Code I(a) to C80, malignant neoplasm, unspecified site.

I (a) Carcinomatosis C80

(b) Metastatic from bowel C260

II Carcinoma of rectum C785

Code I(b) primary neoplasm of bowel. Code the site in Part II as secondary.

b. Malignant neoplasms of morphological type C80 of unspecified site described “to a site” or “metastatic to a site” should be interpreted as secondary of that site(s).

I (a) Metastatic carcinoma to the rectum C785

Code to secondary malignant neoplasm of rectum. The word “to” indicates that the rectum is secondary.

I (a) Metastatic carcinoma to lungs and liver C780 C787

Code I(a) secondary neoplasm of lungs and liver since the record states “metastatic to.”

I (a) Metastatic carcinoma to lungs and liver C780 C787

(b) Bladder carcinoma C679

Code I(a) secondary neoplasm of lungs and liver since it states “metastatic to” and code I(b) primary malignant bladder carcinoma.

I (a) Adenocarcinoma, metastatic to lung C780

Code I(a) secondary neoplasm of lung since the record states “metastatic to.”

c. Malignant neoplasms described as “from a site to a site” should be interpreted as primary of the site stated “from” and secondary of all other sites unless stated primary whether in Part I or Part II

I (a) Metastatic cancer from bowel to liver C787

(b) C260

Code I(a) secondary liver neoplasm. Interpret metastatic cancer from bowel to be a statement of primary and code I(b) primary cancer of bowel.

I (a) Metastatic cancer from liver to abdomen C798

(b) C229

Code secondary malignant neoplasm of abdomen on I(a) and primary malignant neoplasm of liver on I(b).

I (a) Malignant neoplasm of bone from leg C795

(b) C765

Code I(a) secondary bone neoplasm. Interpret metastatic neoplasm of bone from leg to be a statement of primary and code I(b) primary malignant neoplasm of leg.

d. Malignant neoplasm described as (of) a site to a site should be interpreted as primary of the site preceding “to a site” and all other sites should be coded as secondary unless stated as primary, whether in Part I or Part II.

I (a) Cancer of breast C509

(b) Metastatic to mediastinum C781

Code I(a) to primary malignant neoplasm of breast and I(b) to secondary malignant neoplasm of mediastinum since it is reported as “metastatic to.” Enter the codes on the lines where reported.

I (a) Metastatic liver cancer to the brain C229 C793

II Esophageal cancer C788

Code liver cancer as primary since it is the site preceding “to a site” and code other sites as secondary.

I (a) Bladder cancer metastatic to pleura and C679 C782 C780

(b) lung

II History of breast cancer C798

Code I(a) bladder cancer as primary since it is the site preceding “to a site” and code other sites secondary.

e. If the morphological type of neoplasm classifiable to one of the following categories: C40, C41, C43, C44, C45, C46, C49, C70, C71, and C72 is described as “to a site” or “metastatic to a site,” code the morphological type of unspecified site and code the site that follows as secondary.

I (a) Metastatic osteosarcoma to brain C419 C793

Code to malignant neoplasm of bone since this is the unspecified site of osteosarcoma. Code secondary brain neoplasm.

f. Consider any form of the following terms as synonymous with “metastases or metastatic to” when these terms follow or are reported as due to a malignant neoplasm classifiable to C00-C76, C80, C81-C96.

Extension

Infiltration in,

Invasion into, of,

Involvement or to another site

Metastatic

Secondaries

Spread

I (a) Ca of stomach with invasion C169 C780

of lung

Code cancer of stomach primary and invasion of lung as secondary.

I (a) Carcinoma of bladder with C679 C791

(b) infiltration into the ureter

Code carcinoma of bladder as primary and code secondary carcinoma of ureter since it is the site following “infiltration into.”

g. The terms “metastatic” and “metastatic of” should be interpreted as follows:

(1) If one site is mentioned and this is qualified as metastatic, code to malignant primary of that particular site if the morphological type is C80 and the site is not a common site of metastases, excluding lung.

I (a) Metastatic carcinoma of C259

pancreas

Code primary malignant neoplasm of pancreas since one site is reported and it is not a common site.

I (a) Metastatic cancer of lung C349

Code to primary malignant neoplasm of lung since no other site is mentioned.

(2) If no site is reported but the morphological type is qualified as metastatic, code to primary site unspecified of the particular morphological type involved. Do not use “metastatic” to qualify a malignant neoplasm, stated or presumed to be primary, of lymphoid, hematopoietic, and related tissue, classifiable to C81-C96 as secondary.

I (a) Metastatic melanoma C439

Code as indexed. Melanoma is a morphological type of neoplasm and is indexed to C439.

I (a) Metastatic Hodgkin Disease C819

Code a morphological type of neoplasm that is classified to C81-C96 as indexed regardless of whether qualified as metastatic.

(3) Site-specific neoplasms reported as metastatic

(a) When a site specific neoplasm is qualified as metastatic, code as indexed.

I (a) Metastatic hypernephroma C64

Code as indexed. Hypernephroma is a site specific neoplasm and is indexed to C64.

I (a) Metastatic meningioma C709

Metastatic meningioma is a malignant site specific morphological type of neoplasm. Code as indexed under Meningioma, malignant.

(b) If there is a conflict between the code for a site specific neoplasm and the stated site, code the site specific neoplasm as indexed and consider the stated site to be qualified as secondary and code accordingly. Enter the code for the secondary site on the same line with and immediately following the code for the site specific neoplasm.

I (a) Metastatic renal cell carcinoma C64 C780

(b) of lung

Code the site specific neoplasm, renal cell carcinoma followed by the code for secondary neoplasm of lung.

I (a) Metastatic hepatoma of brain C220 C793

Code the site specific neoplasm, hepatoma as indexed followed by the code for secondary brain neoplasm.

(4) If a single morphological type and a site, other than a common site of metastases are qualified as metastatic, code to the specific category for the morphological type and site involved.

I (a) Metastatic melanoma of arm C436

Code to malignant melanoma of skin of arm (C436), since in this case the ill-defined site of arm is a specific site for melanoma, not a common site of metastases classifiable to C76.

I (a) Metastatic sarcoma of stomach C169

Code as indexed.

(5) If a single C80 morphological type is qualified as metastatic and the site mentioned is one of the common sites of metastases except lung, code to secondary malignant neoplasm of the site mentioned. If the single site is lung, qualified as metastatic, code to primary of lung.

I (a) Metastatic cancer of peritoneum C786

Code to secondary cancer of peritoneum since peritoneum is on the list of common sites of metastases and the morphological type of neoplasm is classified to C80.

I (a) Metastatic cancer of lung C349

Code to primary malignant neoplasm of lung, C349, since no other site is mentioned.

(6) If a single morphological type, other than C80 type, is qualified as metastatic and the site mentioned is one of the common sites of metastases except lung, code the unspecified site for the morphological type. Code the common site as secondary and as a second entry on the same line.

I (a) Metastatic rhabdomyosarcoma of C499 C771

(b) hilar lymph nodes

Code to unspecified site for rhabdomyosarcoma and code the lymph nodes as secondary.

I (a) Metastatic sarcoma of lung C349

Code to malignant neoplasm of lung since lung is not considered a common site for this instruction.

Exception: Metastatic mesothelioma or Kaposi sarcoma

1. If site IS indexed under “Mesothelioma" or "Kaposi’s sarcoma,” assign that code.

I (a) Metastatic mesothelioma of liver C457

Code site as indexed under mesothelioma.

I (a) Metastatic mesothelioma of mesentery C451

Code as indexed under mesothelioma.

2. If site is NOT indexed under “Mesothelioma" or "Kaposi’s sarcoma” and site reported is NOT a common site of metastases - assign code for specified site NEC.

I (a) Metastatic mesothelioma of kidney C457

Code mesothelioma specified site NEC. Kidney is not a common site of metastases.

3. If site is NOT indexed under “Mesothelioma" or "Kaposi’s sarcoma” and site reported IS a common site of metastases - assign code for unspecified site and secondary code for common site.

I (a) Metastatic mesothelioma of C459 C779

(b) lymph nodes

Code the morphological type as the first entry followed by the code for the site not indexed under mesothelioma.

I (a) Metastatic Kaposi’s of brain C469 C793

Code the morphological type and code brain as secondary. Brain is on the list of common sites of metastases.

I (a) Kaposi’s sarcoma of brain C467

This instruction does not apply since Kaposi's sarcoma is not qualified as metastatic. Code Kaposi’s sarcoma, specified site, since not qualified as metastatic.

(7) When morphological types of neoplasms classifiable to C40, C41, C43, C44, C45, C46, C47, C49, C70, C71, and C72 without mention of a site are jointly reported with the same morphological type of neoplasm with mention of a site, code the morphological type of unspecified site as indexed.

I (a) Metastatic rhabdomyosarcoma C499

(b) Rhabdomyosarcoma kidney C64

Code to unspecified site of rhabdomyosarcoma on I(a) and code rhabdomyosarcoma kidney as indexed.

h. More than one malignant neoplasm qualified as metastatic.

(1) If two or more sites with a morphology of C80, not on the list of common sites of metastases, are reported and all are qualified as “metastatic” code as follows:

(a) If the sites are in the same anatomical system code each site as primary.

C150-C269 Digestive system

C300-C399 Respiratory system

C400-C419 Bone and articular cartilage of limbs, other, and unspecified sites

C490-C499 Connective and soft tissue

C510-C579 Female genital organ

C600-C639 Male genital organ

C64-C689 Urinary organ

C690-C699 Eye and adnexa

C700-C729 Central nervous system

C73 -C759 Thyroid and other endocrine glands

I (a) Metastatic stomach carcinoma C169

(b) Metastatic pancreas carcinoma C259

Code both sites primary since they are a C80 morphological type, are in the same organ system, and neither is on the list of common sites of metastases.

(b) If the sites are in different anatomical systems, code each as secondary.

I (a) Metastatic carcinoma of stomach C788

(b) Metastatic carcinoma of bladder C791

Code secondary neoplasm of each site listed. Stomach and bladder are in two different anatomical systems.

(2) If two or more morphological types are qualified as metastatic, code to malignant neoplasms, each independent of the other.

I (a) Metastatic adenocarcinoma of bowel C260

(b) Metastatic sarcoma of uterus C55

Code to primary neoplasm of each site since adenocarcinoma and sarcoma are of different morphological types.

I (a) Metastatic cancer of pleura C782

(b) Metastatic melanoma of back C435

Code I(a) to secondary neoplasm of pleura since pleura is on the list of common sites of metastases. Code I(b) to melanoma of back (C435) from the site list under melanoma.

(3) If a morphology implying site and an independent anatomical site are both qualified as metastatic, code to secondary malignant neoplasm of each site.

I (a) Metastatic colonic and renal cell C785 C790

carcinoma

Code both sites as secondary.

(4) If more than one site with a morphology of C80 is mentioned code as follows:

(a) If all but one site is qualified as metastatic and/or appear on the list of common sites of metastases, including lung, code to primary neoplasm of the site that is not qualified as metastatic or not on the list of common sites of metastases, irrespective of the order of entry or whether it is in Part I or Part II. Code all other sites as secondary.

I (a) Metastatic carcinoma of stomach C788

(b) Carcinoma of gallbladder C23

Code primary carcinoma of gallbladder since it is the only site not specified as metastatic. Assign a primary code on I(b) and secondary codes on I(a) and I(c).

I (a) Metastatic carcinoma of stomach C788

(b) Metastatic carcinoma of lung C780

II Carcinoma of colon C189

Code I(a) and I(b) secondary and code primary carcinoma of colon in Part II since this is the only malignant neoplasm not qualified as metastatic, even though it is in Part II.

I (a) Cancer of kidney C64

(b) Metastatic cancer of prostate C798

Code I(a) primary cancer of kidney since the only other site on the record is qualified as metastatic. Code I(b) secondary cancer of prostate since it is qualified as metastatic.

I (a) Metastatic cancer of ovary C796

II Cancer of colon C189

Code I(a) secondary and code part II primary. There are two sites reported and one is qualified as metastatic while the second site is not reported metastatic.

(b) If all sites are qualified as metastatic and/or are on the list of common sites of metastases, including lung, code to secondary malignant neoplasm of all reported sites.

I (a) Metastatic cancer of stomach C788

(b) Metastatic cancer of breast C798

Code secondary neoplasm of each site listed. All sites are reported as metastatic.

I (a) Metastatic carcinoma of ovary C796

(b) Carcinoma of lung C780

Code to secondary malignant neoplasm of each site. Lung is on the list of common sites of metastases and ovary and pancreas are both reported as metastatic.

I (a) Metastatic stomach cancer C788

(b) Lung cancer C780

Code to secondary malignant neoplasm of each site. Lung is on the list of common sites of metastases and stomach cancer is reported as metastatic.

I (a) Carcinoma of spine C795

(b) Metastatic lung cancer C780

Code to secondary malignant neoplasm of each site. Spine is on the list of common sites of metastases and lung is reported as metastatic.

I (a) Metastatic carcinoma of abdomen C798

(b) Metastatic carcinoma of colon C785

Code both sites as secondary since both are qualified as metastatic.

I (a) Metastatic brain carcinoma C793

(b) Metastatic lung carcinoma C780

Code both sites as secondary malignant neoplasm since both are qualified as metastatic.

(c) If one site is qualified as metastatic and there are other sites specified as "secondary", "metastases", "metastasis", "spread", or a statement of "metastasis NOS" or "metastases NOS", code the site qualified metastatic as primary and all other sites secondary, whether in Part I or Part II. If, however, lung is mentioned in one part and the metastatic neoplasm in the other part, code lung primary.

I (a) Metastatic breast cancer with brain metastases C509 C793

II Lung cancer C349

Code I(a) as primary cancer of breast since there is a statement of metastases on the record. Code brain metastases as secondary since metastases are always secondary. Code Part II as primary lung cancer since it is reported in a different part from the metastatic neoplasm.

(5) When a metastatic malignant neoplasm is reported on a record with a malignant neoplasm of the same site whether stated as metastatic or not, code both primary.

I (a) Metastatic gastric carcinoma C169

(b) Gastric carcinoma C169

Code primary gastric carcinoma on I(a) and code primary gastric carcinoma on I(b).

(6) If two or more sites with a morphology of C40, C41, C43, C44, C45, C46, C47, C49, C70, C71, and C72 are reported and all sites are qualified as metastatic, add an additional code to identify the morphological type of neoplasm. Code the morphological type of neoplasm to the unspecified site category, i.e., to “9.” Enter this code on the same line with and preceding the code for the first mentioned secondary site.

I (a) Metastatic leiomyosarcoma arm, C499 C798 C788 C793

stomach and brain

Code leiomyosarcoma, the morphological type of neoplasm, to C499 and code the reported sites as secondary neoplasms since all three sites are qualified as metastatic.

I (a) Metastatic sarcoma of stomach and C499 C788 C784

small intestine

Code the sarcoma, the morphological type of neoplasm, to C499 and code the reported sites as secondary neoplasms.

I (a) Metastatic squamous cell carcinoma of head and neck C449 C798

Since the reported sites are marked with a # sign in the Index, code the morphological type to malignant neoplasm of skin, C449, and code the reported sites as secondary neoplasms.

I (a) Metastatic squamous cell carcinoma of head C449 C798

(b) Metastatic squamous cell carcinoma of neck C798

Since the reported sites are marked with a # sign in the Index, code the morphological type to malignant neoplasm of skin, C449, and code the reported sites as secondary neoplasms. Enter C449 for the morphological type as first code on I (a) preceding the first secondary site. Enter only the secondary code on line b.

9. Primary site unknown

Consider the following terms as equivalent to “primary site unknown

? Origin (Questionable origin)

? Primary (Questionable primary)

? Site (Questionable site)

? Source (Questionable source)

Undetermined origin

Undetermined primary

Undetermined site

Undetermined source

Unknown origin

Unknown primary

Unknown site

Unknown source

a. When the statement, “primary site unknown,” or its equivalent, appears anywhere on the certificate with a site specific neoplasm or a neoplasm classifiable to C81-C96, code the neoplasm as though the statement did not appear on the certificate.

I (a) Renal cell carcinoma C64

(b) Primary site unknown

Code renal cell carcinoma (C64) as though the statement “primary site unknown” was not on the certificate.

I (a) Reticulum cell sarcoma C833

II Undetermined source

Code reticulum cell sarcoma (C833) as though the statement “undetermined source” was not on the certificate.

b. When primary site unknown or its equivalent appears on the certificate with a morphological type of neoplasm classifiable to C40, C41, C43, C44, C45, C46, C47, C49, C70, C71, and C72, add an additional code to identify the morphological type of neoplasm. Code the morphological type of neoplasm to the unspecified site category. This additional code should be entered on the same line with and preceding the code for the first mentioned secondary site.

I (a) Generalized metastases C80

(b) Melanoma of back C439 C798

Code I(b) melanoma, unspecified site, followed by the code for the secondary site reported.

c. When “primary site unknown,” or its equivalent, appears on the certificate with neoplasms classified to morphological type C80, (classifiable to C00-C76), code all reported sites as secondary and precede the first neoplasm code with C80.

I (a) Secondary carcinoma of liver C80 C787

(b) Primary site unknown

Code secondary liver carcinoma preceded with C80.

I (a) Carcinoma of stomach C80 C788

(b) Primary site unknown

Code secondary stomach carcinoma preceded with C80.

I (a) Carcinoma of stomach C80 C788

(b) Primary site of carcinoma unknown C80

Code I(a) secondary carcinoma of stomach preceded with C80. Code I(b) C80 for carcinoma since the term carcinoma is repeated.

I (a) Cancer of intestines, stomach, C80 C785 C788 C798

(b) and abdomen

Code all sites as secondary; precede the first code with C80.

d. When "primary site unknown" or its equivalent appears on the certificate and a doubtful expression such as presumed or probably is reported qualifying a specific site(s), interpret the primary to be the site(s) following the doubtful qualifying expression and code as primary.

I (a) Cancer, unk primary, presumed lung C349

(b) Primary site unknown

Code primary lung cancer.

10. Primary examples

a. When a morphological type of C80, not qualified as metastatic, is reported with a
site stated to be primary, code primary of the site.

I (a) Carcinoma, breast primary C509

Code primary malignant neoplasm of breast.

b. When a morphological type of C80 is qualified as metastatic and reported with a site stated to be primary, code C80 and primary of the site.

I (a) Metastatic cancer (primary bladder) C80 C679

Code C80 and primary cancer of the bladder.

I (a) Mestastatic cancer probably breast primary C80 C509

Code C80 and primary cancer of the breast.

11. Implication of malignancy

Mention on the certificate that a neoplasm has produced metastases (secondaries) means it must be coded as malignant, even though this neoplasm without mention of metastases would be classified to some other section of Chapter II.

Code neoplasms indexed to D00-D09 (in situ neoplasms), D10-D36 (benign neoplasms), or D37-D48 (neoplasms of uncertain or unknown behavior) to a primary malignant neoplasm category in C00-C76 (whether or not on the list of common sites of metastases and even if modified by qualifiers such as benign) if reported anywhere on the record with the following conditions:

a. Metastases NOS and metastases of a site

I (a) Breast tumor with metastases C509 C80

Code I(a) to primary malignant neoplasm of breast and code metastases NOS. Code breast tumor as malignant neoplasm of breast since it is reported with metastases NOS.

I (a) Brain metastasis C793

(b) Lung tumor C349

Code I(a) secondary neoplasm of brain and I(b) primary malignant neoplasm of lung since the lung tumor is reported with metastases of a site.

I (a) Lung cancer with metastasis C349 C80

II Hypertension, Benign spinal cord tumor I10 C720

Code I(a) to primary malignant neoplasm of lung and code metastasis NOS. Code benign spinal cord tumor as malignant neoplasm of spinal cord since it is reported with metastases NOS.

b. Any neoplasm indexed to C77-C79 in Volume III

I (a) Lymph node cancer C779

(b) Carcinoma in situ of breast C509

Code the carcinoma in situ of breast as primary malignant neoplasm of breast since it is reported with a neoplasm that is indexed to C779. Malignant neoplasm of lymph node is indexed to secondary neoplasm.

c. A common site of metastases (excluding lung) qualified by the word “metastatic.”

I (a) Metastatic liver cancer C787

(b) Small intestine tumor C179

Code I(a) as secondary neoplasm of liver and code primary malignant neoplasm of small intestine on I(b), since the small intestine tumor is reported with a common site of metastases qualified by the word “metastatic.”

d. If a, b, or c do not apply, code the neoplasm in D00-D09, D10-D36, D37-D48 as indexed.

12. Sites with prefixes or imprecise definitions

Neoplasms of sites prefixed by “peri,” “para,” “supra,” “infra,” etc. or described as in the “area” or “region” of a site, unless these terms are specifically indexed, should be coded as follows: for morphological types classifiable to one of the categories C40, C41, C43, C44, C45, C46, C47, C49, C70, C71, and C72, code to the appropriate subdivision of that category; otherwise, code to the appropriate subdivision of C76 (other and ill-defined sites).

I (a) Fibrosarcoma in the region of the leg C492

Code I(a) fibrosarcoma in the region of the leg to the appropriate subdivision of the category, malignant neoplasm of connective and soft tissue of lower limb.

I (a) Carcinoma in lung area C761

Since the morphological type of the term “carcinoma” is C80, code I(a), carcinoma in lung area, to the appropriate subdivision of C76 (other and ill-defined sites).

13. Malignant neoplasms described with “either/or”

Malignant neoplasms of more than one site described as “or” and both sites are classified to the same anatomical system, code the residual category for the system. If the sites are in different systems, and are in the same morphological category, code to the residual category for the morphological type.

I (a) Cancer of kidney or bladder C689

Code C689, malignant neoplasm of other and unspecified urinary organs.

I (a) Cancer of gallbladder or kidney C80

Code to C80, malignant neoplasm without specification of site since there is more than one site qualified by the statement “or” and the sites are in different systems.

I (a) Osteosarcoma of lumbar vertebrae C419

(b) or sacrum

Code to malignant neoplasm of bone unspecified (C419). Both sites separated by the “or” are indexed to bone.

14. Mass or lesion with malignant neoplasms

When mass or lesion is reported with malignant neoplasms, code mass or lesion as indexed.

I (a) Lung mass R91

(b) Carcinomatosis C80

Code mass as indexed. Do not consider as malignant mass.

I (a) Metastatic lung carcinoma C349

II Lung lesion J984

Code lung lesion as indexed.

B. Rheumatic heart diseases

1. Heart diseases considered to be described as rheumatic

a. When rheumatic fever (I00) or any heart disease that is specified as rheumatic is reported anywhere on the death certificate, consider conditions listed in categories I300-I319, I339, I340-I38, I400-I409, I429, and I514-I519 to be described as rheumatic unless there is indication they were due to a nonrheumatic cause.

I (a) Myocarditis I090

(b) Rheumatic heart disease I099

Consider “myocarditis” to be described as “rheumatic” since reported with a heart disease specified as rheumatic.

I (a) Cardiac tamponade I092

(b) Rheumatic endocarditis I091

(c)

Consider “cardiac tamponade” to be described as “rheumatic” since reported with a heart disease specified as rheumatic.

b. When rheumatic fever and a heart disease are jointly reported, enter a separate code for the rheumatic fever only when it is not used to qualify a heart disease as rheumatic. This applies whether or not the heart disease is stated or classified as rheumatic.

I (a) Heart disease I099

(b) Rheumatic fever

Consider “heart disease” to be described as “rheumatic.” Do not enter a separate code for rheumatic fever since it is used to qualify the heart disease as rheumatic.

I (a) Rheumatic heart disease I099

(b) Rheumatic fever

Code “rheumatic heart disease” as indexed. Do not enter a separate code for rheumatic fever since the heart disease is qualified as rheumatic.

I (a) Cardiac arrest I469

(b) Rheumatic fever I00

Cardiac arrest is not one of the conditions considered to be described as rheumatic when reported with rheumatic fever. Code each condition as indexed.

c. When a condition listed in category I50.- is indicated to be due to rheumatic fever and there is no mention of another heart disease that is classifiable as rheumatic, consider the condition in I50.- to be described as rheumatic.

I (a) Heart failure I099

(b) Rheumatic fever

Since there is no other heart disease classified as rheumatic, use the rheumatic fever to qualify the heart disease on I(a) as rheumatic.

I (a) Heart failure I509

(b) Rheumatic heart disease I099

Since there is a heart disease qualified as rheumatic reported on the record, code heart failure, I509.

2. Distinguishing between active and chronic rheumatic heart disease

Rheumatic heart diseases are classifiable to I010-I019, Rheumatic fever with heart involvement, or to I050-I099, Chronic rheumatic heart diseases, depending upon whether the rheumatic process was active or inactive at the time of death.

a. When rheumatic fever or any rheumatic heart disease is stated to be active, recurrent, or recrudescent, code all rheumatic heart diseases as active. Conversely, code all rheumatic heart diseases as inactive if rheumatic fever or any rheumatic heart disease is stated to be inactive.

I (a) Endocarditis I011

(b) Active rheumatic fever

Code I(a), active rheumatic endocarditis since the rheumatic fever is stated as active. Leave I(b) blank.

I (a) Heart failure I509

(b) Inactive rheumatic heart disease I099

(c)

Code I(a) as indexed since another heart disease classified as rheumatic is reported. Code I(b) as indexed since stated as inactive.

b. When there is no statement of active, recurrent, recrudescent, or inactive, code all heart diseases that are stated to be rheumatic or that are considered to be described as rheumatic as active if any of the following instructions apply:

(1) The interval between onset of rheumatic fever and death was less than one year.

I (a) Endocarditis - 6 months I011

(b) Rheumatic fever - 9 months

(2) One or more of these heart diseases (listed in Section IV, Part B, 1, a) is stated to be acute or subacute.

NOTE: This does not mean rheumatic fever stated to be acute or subacute.

I (a) Acute myocarditis I012

(b) Rheumatic heart disease I019

I (a) Rheumatic heart disease I099

(b) Acute rheumatic fever

(3) One of these heart diseases is pericarditis.

I (a) Pericarditis I010

(b) Rheumatic heart disease I019

(4) At least one of these heart diseases is “carditis,” “endocarditis” (any valve), “heart disease,” “myocarditis,” or “pancarditis” with a stated duration of less than one year.

I (a) Endocarditis - 9 months I011

(b) Rheumatic heart disease I019

(5) At least one of these heart diseases is “carditis,” “endocarditis” (any valve), “heart disease,” “myocarditis,” or “pancarditis” without a duration and the age of the decedent was less than 15 years.

Age: 10 years

I (a) Rheumatic heart disease I019

(b) Rheumatic fever

c. In the absence of the previous mentioned indications of an active rheumatic process, consider all heart diseases that are stated to be rheumatic or that are considered to be described as rheumatic as inactive and code to categories I050-I099.

Age: 75 years

I (a) Rheumatic heart disease I099

(b) Rheumatic fever

Code I(a) as indexed, there is no indication the rheumatic process was active. Leave line I(b) blank.

3. Valvular diseases jointly reported

a. When diseases of the mitral, aortic, and tricuspid valves, not qualified as rheumatic, are jointly reported, whether on the same line or on separate lines, code the disease of all valves as rheumatic unless there is indication to the contrary.

I (a) Mitral insufficiency and aortic stenosis I051 I060

(b)

Code both valvular diseases as rheumatic since there is no indication to the contrary.

I (a) Aortic insufficiency I061

(b) Mitral endocarditis with I059 I051

Code the diseases of both valves as rheumatic since there is no indication to the contrary.

I (a) Mitral endocarditis c I059 I051 I050

(b) insufficiency and stenosis

Code the diseases of both valves as rheumatic since there is no indication to the contrary.

I (a) Mitral valve disease I059 I051 I48

(b) with insufficiency and

II Aortic stenosis I060

Code the diseases of both valves as rheumatic since there is no indication to the contrary.

I (a) Valvular heart disease with mitral I091 I050 I060

(b) and aortic stenosis

Code the disease of all valves as rheumatic since there is no indication to the contrary.

b. When mitral insufficiency, incompetence, or regurgitation is jointly reported with mitral stenosis NOS (or synonym), code all these mitral conditions as rheumatic unless there are indications to the contrary.

I (a) Mitral insufficiency with mitral stenosis I051 I050

Code the mitral insufficiency as rheumatic since it is reported with mitral stenosis and there is no indication to the contrary.

I (a) Endocarditis with mitral stenosis and mitral insufficiency I38 I050 I051

Code the endocarditis as nonrheumatic. Code the mitral insufficiency as rheumatic since it is reported with mitral stenosis and there is no indication to the contrary.

4. Valvular diseases not indicated to be rheumatic

In the Classification, certain valvular diseases, i.e., disease of mitral valve (except insufficiency, incompetence, and regurgitation without stenosis) and disease of tricuspid valve are included in the rheumatic categories even though not indicated to be rheumatic. This classification is based on the assumption that the vast majority of such diseases are rheumatic in origin. Do not use these diseases to qualify other heart diseases as rheumatic. Code these diseases as nonrheumatic if reported due to one of the nonrheumatic causes on the following list.

I (a) Pericarditis I319

(b) Mitral stenosis I050

Although mitral stenosis is classified to a rheumatic category, do not use it to qualify the pericarditis as rheumatic.

a. When valvular heart disease (I050-I079, I089 and I090) not stated to be rheumatic is reported due to:

A1690 C73-C759 E804-E806 J030

A188 C790-C791 E840-E859 J040-J042

A329 C797-C798 E880-E889 J069

A38 C889 F110-F169 M100-M109

A399 D300-D301 F180-F199 M300-M359

A500-A549 D309 I10-I139 N000-N289

B200-B24 D34-D359 I250-I259 N340-N399

B376 D440-D45 I330-I38 Q200-Q289

B379 E02-E0390 I420-I4290 Q870-Q999

B560-B575 E050-E349 I511 R75

B908 E65-E678 I514-I5150 T983

B909 E760-E769 I700-I710 Y400-Y599

B948 E790-E799 J00 Y883

C64-C65 E802 J020

Code nonrheumatic valvular disease (I340-I38) with appropriate fourth character.

I (a) Mitral stenosis and aortic stenosis I342 I350

(b) Hypertension I10

Code I(a) as separate one-term entities to nonrheumatic mitral and aortic stenosis since they are reported “due to” a nonrheumatic condition.

I (a) Mitral insufficiency I340

(b) Goodpasture syndrome & RHD M310 I099

Code I(a) to nonrheumatic mitral insufficiency since it is reported “due to” a nonrheumatic condition. Apply this instruction even though rheumatic heart disease is entered as the second entry on I(b).

b. Consider diseases of the aortic, mitral, and tricuspid valves to be nonrheumatic if they are reported on the same line due to a nonrheumatic cause in the previous list. Similarly, consider diseases of these three valves to be nonrheumatic if any of them are reported due to the other and that one, in turn, is reported due to a nonrheumatic cause in the previous list.

I (a) Mitral disease I349

(b) Aortic stenosis I350

Classify both valvular diseases as nonrheumatic. The mitral disease is reported due to the aortic disease which is, in turn, reported due to a nonrheumatic cause.

I (a) Congestive heart failure I500

(b) Mitral stenosis I342

Code the mitral stenosis as nonrheumatic since the certifier indicated it was due to a nonrheumatic cause.

I (a) Aortic and mitral insufficiency I351 I340

(b) Subacute bacterial endocarditis I330

Code the valvular diseases as nonrheumatic since they are reported due to a nonrheumatic cause.

C. Pregnancy, childbirth, and the puerperium (O00-O99)

1. General information

Conditions classifiable to categories O00-O99 are limited to deaths of females of childbearing age. Some of the maternal conditions are also the cause of death in newborn infants. Always refer to the age and sex of the decedent before coding a condition to O00-O99.

Obstetric deaths are classified according to time elapsed between the obstetric event and the death of the woman:

O95 Obstetric death of unspecified cause

O960-O969 Death from any obstetric cause occurring more than 42 days but less than one year after delivery

O970-O979 Death from sequela of obstetric causes (death occurring one year or more after delivery)

The standard certificate of death contains a separate item regarding pregnancy. Any positive response to one of the following items should be taken into consideration when coding pregnancy related deaths:

✚ Pregnant at time of death

✚ Not pregnant, but pregnant within 42 days of death

✚ Not pregnant, but pregnant 43 days to 1 year before death

If one of the options from the previous list is marked and the decedent is greater than 44 years old, code as pregnancy record only when there is a condition reported which indicates the person was pregnant either at the time of death or pregnant 43 days to 1 year before death.

Additionally, if the third option is checked, but there is a maternal condition reported with a duration that indicates the pregnancy was within 42 days of death, disregard the checkbox and prefer the duration.

The following are valid single character codes used in the separate checkbox item regarding pregnancy on some variations of the standard death certificate. These codes are to be taken into consideration when coding pregnancy related deaths.

1 - Not pregnant within the past year

2 - Pregnant at the time of death

3 - Not pregnant, but pregnant within 42 days of death

4 - Not pregnant, but pregnant 43 days to 1 year before death

7 - Not on certificate

8 - Not applicable

9 - Unknown

Consider the pregnancy to have terminated 42 days or less prior to death unless a specific length of time is written in by the certifier. Take into consideration the length of time elapsed between pregnancy and death if reported as more than 42 days.

Maternal deaths are subdivided into two groups:

Direct obstetric deaths (O00-O97): those resulting from obstetric complications of the pregnant state (pregnancy, labor and puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above.

Indirect obstetric deaths (O98-O99): those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy.

When coding pregnancies, code any direct obstetric cause to O00-O97 and any indirect obstetric cause to O98-O99.

2. Checkbox only

If the only indication of pregnancy is in the checkbox, do not convert any reported conditions to maternal categories (O00-O99).

Female, 34 years

I (a) Rheumatic heart disease I099

(b)

Pregnancy: Pregnant at time of death

Code I(a) as indexed since the only indication of pregnancy is in the checkbox.

Female, 34 years

I (a) Right heart failure I500

(b) Pulmonary hypertension I272

Pregnancy: Not pregnant, but pregnant 43 days to 1 year before death

Code I(a) and I(b) as indexed since the only indication of pregnancy is in the checkbox.

Female, 34 years

I (a) Pulmonary embolism I269

(b) Right heart failure I500

Pregnancy: Not pregnant, but pregnant within 42 days of death

Code I(a) and I(b) as indexed since the only indication of pregnancy is in the checkbox.

3. Pregnancy or childbirth without mention of complication

a. Do not assign a separate code for “pregnancy” or “delivery” if any other condition is reported other than laboratory evidence of human immunodeficiency virus [HIV] (R75) and /or nature of injuries and external causes (S000-Y899).

Female, 39 years

Place I (a) Asphyxia by hanging T71 &X70

9 (b)

MOD II 1st trimester pregnancy O95

Suicide

Code I(a) to nature of injury and external cause. Code pregnancy in Part II to Pregnancy, death from (O95) since the only other reported condition is classified to a nature of injury and external cause.

b. When pregnancy or delivery is the only entry on the certificate, apply the following instructions:

(1) Code to category O95 if death occurred 42 days or less after termination of pregnancy or when there is no indication of when the pregnancy terminated.

Female, 28 years

I (a) Pregnancy O95

Code “pregnancy” to Pregnancy, death from (O95) since it is the only entry on the certificate.

(2) Code to category O969 if death resulted from direct or indirect obstetric
causes that occurred more than 42 days but less than one year after termination of the pregnancy.

Female, 28 years

I (a) Childbirth - 3 months O969

Code childbirth to death from any obstetric cause occurring more than 42 days but less than one year after delivery.

(3) Code to category O979 if death occurred 1 year or more after termination of pregnancy.

Female, 28 years

I (a) Pregnancy - 1 year O979

Code to death from sequela of an obstetric cause.

4. Pregnancy with an external event reported

When an external event is reported with pregnancy or a maternal related condition, code conditions reported due to the external as indexed and do not convert to a maternal category, whether or not the maternal checkbox is marked. For conditions not reported due to the external event, apply the maternal instructions.

Female, 34 years

Place I (a) Anoxic brain injury G978

9 (b) CPR due to cardiopulmonary arrest Y848

MOD (c) Acute cocaine intoxication I469

A (d) T405 &X42

II Asthma, pregnancy, status post C-section O995 O759 T405

Pregnancy: Not pregnant, but pregnant within 42 days of death

Accident

Self-administered cocaine

Code anoxic brain injury and cardiopulmonary arrest to appropriate non-maternal code since both are reported due to external causes. Convert the remaining conditions to the appropriate maternal category since they are not reported due to an external, and a maternal condition is reported in Part II.

Female, 34 years

I (a) Anoxic brain injury G978

(b) CPR due to cardiopulmonary arrest Y848

(d)

II Asthma, C-section O995 O759

Pregnancy: Not pregnant, but pregnant within 42 days of death

Code I (a) anoxic brain injury to appropriate non-maternal code since reported due to CPR an external. Convert the remaining conditions to the appropriate maternal category since they are not reported due to an external, and a maternal condition is reported in Part II.

Female, 24 years

Place I (a) Cardiorespiratory arrest I469

9 (b) Fentanyl overdose T404 &X42

MOD (c)

A (d)

II Remote history of opiate abuse F111 T404

Pregnancy: Pregnant at time of death

Accident

Fentanyl overdose

Code I (a) cardiorespiratory arrest to appropriate non-maternal code since reported due to poisoning, an external. Code the poisoning as indexed. Since the only indication of pregnancy is in the checkbox, code the Part II term as indexed and do not convert to an O-code.

Female, 24 years

Place I (a) Fentanyl overdose T404 &X42

9 (b)

MOD (c)

A (d)

Pregnancy: Pregnant at time of death

Accident

Code I (a) poisoning as indexed. Since the only indication of pregnancy is the checkbox, no O-code is assigned in Part II.

5. Pregnancy with abortive outcome (O000-O089)

a. Code all complications of conditions listed in categories O000-O029 to the appropriate subcategory of O08 and also code O000-O029 as indexed. To determine the appropriate subcategory for O08, refer to the Index under Abortion, complicated by and select appropriate fourth character from last column.

Female, 28 years

I (a) Septicemia O080

(b) Tubal pregnancy O001

Code I(a) Abortion, complicated by, septicemia (O080) and I(b) Pregnancy, tubal (O001).

Female, 20 years

I (a) Shock O083

(b) Ectopic pregnancy O009

Code I(a) Abortion, complicated by, shock (O083) and I(b) Ectopic, pregnancy (O009).

b. Code all complications of conditions listed in categories O03-O07 to the appropriate subcategory of O08 and also code O03-O07 with fourth character “9.” To determine the appropriate subcategory for O08, refer to the Index under Abortion, complicated by and select appropriate fourth character from last column.

Female, 22 years

I (a) Pulmonary embolism O082

(b) Spontaneous abortion O039

Code I(a) Abortion, complicated by, pulmonary embolism (O082) and I(b) Abortion, spontaneous (O039).

c. When conditions in categories O00-O07 are reported in Part I or Part II of the death certificate with:

(1) a direct obstetric complication classifiable to category O08, code the complication to category O08 with the appropriate fourth character. Also code O00-O02 as indexed or O03-O07 with fourth character “9.”

Female, 31 years

I (a) Cardiac arrest O088

(b) Abortion O069

Code I(a) Abortion, complicated by, cardiac arrest, a direct obstetric complication and I(b) Abortion NOS.

(2) an indirect obstetric complication classifiable to categories O98-O99, code the O98-O99. Also code the O00-O02 as indexed or O03-O07 with fourth character “9.”

Female, 25 years

I (a) Abortion O069

II Rheumatic heart disease O994

Code I(a) Abortion NOS (O069). Code Pregnancy, complicated by, conditions in, I00-I09 (O994), an indirect obstetric cause.

(3) both a direct and an indirect obstetric complication, code the direct complications to O08 with the appropriate fourth character and the indirect complications to O98-O99. Also code the O00-O02 as indexed or O03-O07 with fourth character “9.”

Female, 33 years

I (a) Renal failure O084

(b) Abortion O069

II Anemia O990

Code I(a) Abortion, complicated by, renal failure. Direct complications of abortions are classified to category O08 with the appropriate fourth character. Code I(b) Abortion NOS. Code Part II Pregnancy, complicated by, anemia, an indirect obstetric complication.

6. Other complications of pregnancy, childbirth and puerperium (O00-O99)

a. If death occurred more than 42 days but less than 1 year after termination of pregnancy, code all direct and indirect obstetric complications to O960-O969.

Female, 28 years

I (a) Cardiomyopathy O960

(b) Childbirth 3 months

Code cardiomyopathy as a direct obstetric cause occurring more than 42 days but less than 1 year after childbirth.

Female, 28 years

I (a) Intracerebral hemorrhage O961

(b) Childbirth 3 months

Code intracerebral hemorrhage as an indirect obstetric cause occurring more than 42 days but less than 1 year after childbirth.

b. If death occurred 1 year or more after termination of pregnancy, code all direct and indirect obstetric complications to O970-O979.

Female, 28 years

I (a) Cardiomyopathy O970

(b) Childbirth 1 year

Code to O970, Death from sequela of direct obstetric causes. Cardiomyopathy is a direct obstetric cause. Do not enter a code on I(b) for childbirth.

Female, 28 years

I (a) Intracerebral hemorrhage O971

(b) Childbirth 1 year

Code to O971, Death from sequela of indirect obstetric cause. Intracerebral hemorrhage is an indirect obstetric cause. Do not enter a code on I(b) for childbirth.

c. Code all complications of pregnancy, childbirth, and the puerperium to categories O00-O75, O85-O92, O96-O99. When delivery is mentioned on the certificate, consider complications to be of delivery unless otherwise specified.

(1) When both direct and indirect obstetric causes are reported on the same certificate code as indexed to appropriate code in Chapter XV.

(2) When a complication is reported and not indexed to a direct or indirect obstetric code, assign the complication to O98-O99 with the appropriate fourth character. Refer to Volume I for correct code assignment.

Female, 35 years

I (a) Thrombosis 1 hr O229

(b) Pregnancy 8 mos

II Obesity O992

Code I(a) to Pregnancy, complicated by, thrombosis. Do not enter a code on I(b) for pregnancy. Code Part II to Pregnancy, complicated by, endocrine diseases NEC as indexed. Obesity is an endocrine disorder.

Female, 29 years

I (a) Acute anemia O990

(b) Massive postpartum hemorrhage O721

Code I(a) to Anemia, complicating pregnancy, childbirth or the puerperium, an indirect obstetric cause. Code I(b) to Hemorrhage, postpartum, a direct obstetric cause. Do not enter a code on I(c) for delivery NOS.

Female, 21 years

I (a) Gram negative sepsis O988

(b) Congenital anomalies of ureters O998

II 30 weeks pregnant

Code I(a) to Pregnancy, complicated by, septicemia, an indirect obstetric cause. Code I(b) to Pregnancy, complicated by, congenital malformation, an indirect obstetric cause. Do not enter a code in Part II for pregnancy.

Female, 28 years

I (a) Aspiration pneumonia O995

(b) Delivery

II Rubella in first trimester O985

Code the indirect causes, aspiration pneumonia and rubella to the appropriate code in Chapter XV. Do not enter a code for delivery on I(b).

7. Delivery reported with anesthetic death or anesthesia

a. When delivery (normal) NOS is reported with anesthetic death, code O748 only. When reported with anesthesia, code O749 only.

Female, 29 years

I (a) Anesthetic death O748

(b) Delivery

Code I(a) to O748, other complications of anesthesia during labor and delivery. Do not enter code on I(b) for delivery.

b. When anesthetic death is reported with a complication(s) of delivery or puerperium, code O748 and the code(s) for complication(s) of pregnancy, delivery, or puerperium.

Female, 26 years

I (a) Anesthetic death O748

(b) Obstructed labor O669

Code Delivery, complicated by, anesthetic death on I(a). Code I(b) as indexed.

c. When anesthesia is reported with a complication(s) of delivery or puerperium, code O749 and the code(s) for complication(s) of pregnancy, delivery, or the puerperium.

Female, 28 years

I (a) Prolonged labor O639

(b) Anesthesia - delivery O749

Code prolonged labor as a complication of delivery. Code “anesthesia-delivery” to O749.

Female, 34 years

I (a) Cardiac arrest O742

(b) Anesthesia O749

Code I(a) cardiac arrest as a complication of anesthesia. Code the anesthesia on I(b) to O749. Code I(c) as indexed.

8. Operative delivery

a. Code an operative delivery such as cesarean section or hysterectomy to O759.

b. Code reported complications of the operative delivery to complications of obstetric surgery (O754).

c. Code conditions reported due to complications of operative delivery as indexed under complication of delivery and/or the puerperium.

Female, 18 years

I (a) Cardiac arrest O742

(b) Anesthesia during C-section O749

(d) O459

Code I(a) cardiac arrest as a complication of anesthesia. Code O749 for the anesthesia. There is no complication of the C-section; therefore, code the C-section to O759. Code premature separation of placenta as indexed on line I(d).

Female, 27 years

I (a) Pulmonary embolism O882

(b) Pelvic thrombosis O754

Code I(a) Puerperal, embolism (pulmonary). Code I(b) as a complication of the operative delivery. Code I(c) Delivery, cesarean, as indexed.

Female, 39 years

I (a) Pneumonia O995

(b) Peritoneal hemorrhage O754

Code I(a) O995, an indirect obstetric cause. Pneumonia is reported due to the complication and coded as complicating delivery. Code I(b) as a complication of the operative delivery. Code I(c) Delivery, cesarean, as indexed.

Female, 30 years

I (a) Pneumonia 24 hr O995

(b) Pulmonary embolism 3 days O754

II O759

Operation Block: C-section

Code I(a) an indirect obstetric cause. Code I(b) as a complication of the operative delivery reported in Part II. Code Part II cesarean section as indexed.

Female, 28 years

I (a) Pneumonia O754

(b) C-section O759

II O759 O321

Operation Block: C-section for breech presentation

Code I(a) as a complication of the operative delivery. Code cesarean section on I (b) as indexed. Code cesarean section and breech presentation as indexed in Part II.

D. Congenital conditions

1. The Classification does not provide congenital and acquired codes for all conditions. When no provision is made for a distinction, disregard the statement or implication of congenital or acquired and code the NOS code.

Female, 45 years

I (a) Patent ductus arteriosus - acquired Q250

(b) Pneumonia J189

Code I(a) to Q250 since patent ductus arteriosus does not have an acquired code.

Male, 33 years

I (a) Gastric hemorrhage K922

(b) Gastric ulcer - congenital K259

Code I(b) to K259 since gastric ulcer does not have a congenital code.

Male, 33 years

I (a) Cardiorespiratory failure R092

(b) Hypoxic ischemic encephalopathy - at birth I678

Code I(b) to I678 since it does not have a congenital code.

2. When a condition specified or implied as “congenital” is reported “due to” another condition not specified as congenital, code both conditions as congenital.

Male, 2 months

I (a) Peritonitis - birth P781

(b) Intestinal obstruction Q419

Code the condition on I(b) as congenital.

3. Code hydrocephalus (G91.0, 1, 2, 8, 9) (any age) to Q039 (congenital hydrocephalus) when it is reported with another cerebral or other central nervous system condition (Q00-Q07, Q280-Q283) which is classified as congenital.

Male, 3 months

I (a) Cerebral anoxia G931

(b) Hydrocephalus & hypoplasia Q039 Q061

Code hydrocephalus NOS to Q039 since the hypoplasia of spinal cord is classified as congenital.

Male, 3 months

I (a) Cerebral anoxia G931

(b) Hydrocephalus Q039

II Meningomyelocele Q059

Code the hydrocephalus NOS to Q039 since the meningomyelocele is classified as congenital.

E. Conditions of early infancy (P000-P969)

1. When reported on certificate of infant, code the following entries as indicated:

Birth weight of 2 pounds (999 gms) or under.................................... P070

Over 2 pounds (1000 gms) but not more than

5 ½ pounds (2499 gms)........................................... P071

10 pounds (4500 gms) or more................................. P080

Gestation of Less than 28 weeks................................................. P072

28 weeks but less than 37 weeks.............................. P073

42 or more completed weeks.................................... P082

Premature labor or delivery NOS.................................................................. P073

Female, 3 hours

I (a) Respiratory distress syndrome P220

(b) Prematurity P073

II 26 weeks gestation P072

Code Gestation, less than 28 weeks to P072.

Male, 8 hours

I (a) Respiratory failure P285

(b) Prematurity, 23 weeks P073 P072

Code I(b) as two separate conditions. Code prematurity as indexed P073 and code P072 for “23 weeks.” The 23 weeks is an implied length of gestation.

2. When a multiple birth or low birth weight is reported on an infant’s death certificate outside of Part I or Part II, code this entity as the last entry in Part II.

Male, 29 minutes - Twin A

I (a) Immature P073

(b) Weight 1,500 grams - twin P071 P015

II Atelectasis P281 P015

Code “twin” as the last entry in Part II.

Male, 5 minutes

4 lbs. I (a) Immaturity of lung P280

(b)

(c)

II P071

Code P071 for “4 lbs.” as last entry in Part II.

3. When “termination of pregnancy” or “abortion” (legal) other than criminal is the only reported cause of an infant death, code P964. Do not code P964 if any other codable entry is reported.

Female, 3 minutes

I (a) Legal abortion P964

Since “legal abortion” is the only entry on the certificate, code P964, as indexed.

4. When a condition classifiable to P703-P720, P722-P749 is the only cause(s) reported on a newborn’s death, code P969. If reported with other perinatal conditions, code as indexed.

Male, 7 days

(a) Hypomagnesemia P969

(b)

(c)

Code the hypomagnesemia to P969, even though it is indexed to P712 since it is the only cause of death reported.

Female, 2 weeks

(a) Hypoglycemia P704

(b) Maternal diabetes P701

Code I(a) as indexed since reported with another perinatal condition.

F. Sequela

A sequela is a late effect, an after effect, or a residual of a disease, nature of injury or external cause. ICD-10 provides sequela codes for the following conditions:

B900-B909 Sequela of tuberculosis

B91 Sequela of acute poliomyelitis

B92 Sequela of leprosy

B940-B949 Sequela of other and unspecified infectious and parasitic diseases

E640-E649 Sequela of malnutrition and other nutritional deficiencies

E68 Sequela of hyperalimentation

G09 Sequela of inflammatory diseases of central nervous system

I690-I698 Sequela of cerebrovascular disease

O970-O979 Death from sequela of obstetric causes

T900-T983* Sequela of injuries, of poisoning, and of other consequences of external causes

Y850-Y859* Sequela of transport accidents

Y86* Sequela of other accidents

Y870-Y872* Sequela of intentional self-harm, assault and events of undetermined intent

Y880-Y883* Sequela with surgical and medical care as external cause

Y890-Y899* Sequela of other external causes

* See Section V, Part S for instructions for coding sequela of injuries and external causes.

NOTE #1: When conditions in categories A000-A310, A318-A427, A429-A599, A601-A70, A748-B001, B003-B004, B007, B009-B069, B080, B082-B085, B09-B199, B25-B279, B330-B349, B370-B49, B58- B64, B99 are mentioned on the record with HIV (B20-B24, R75), do not consider the infectious or parasitic condition as a sequela.

NOTE #2: Sequela categories (except G09) do not apply to decedents with an age less than 1 year old.

When there is evidence death resulted from residual effects rather than the active phase of conditions for which the Classification provides a sequela code, code the appropriate sequela category. Code specified residual effects separately. Apply the following instructions to the sequela categories.

1. B900-B909 Sequela of tuberculosis

Use these subcategories for the classification of tuberculosis (conditions in A162-A199) if:

a. A statement of a late effect or sequela of the tuberculosis is reported.

I (a) Pulmonary fibrosis J841

(b) Sequela of pulmonary tuberculosis B909

Code sequela of pulmonary tuberculosis (B909) since “sequela of” is stated.

b. The tuberculosis is stated to be ancient, arrested, by history, cured, healed, history, history of, inactive, old, quiescent, or remote, whether or not the residual (late) effect is specified, unless there is evidence of active tuberculosis.

I (a) Arrested pulmonary tuberculosis B909

Code arrested pulmonary tuberculosis, B909, since there is no evidence of active tuberculosis.

c. When there is evidence of active tuberculosis of a site with inactive (ancient, arrested, by history, cured, healed, history, history of, old, quiescent, remote) tuberculosis of a different site, code both.

d. When there is evidence of active and inactive (ancient, arrested, by history, cured, healed, history, history of, old, quiescent, remote) tuberculosis of the same site, code active tuberculosis of the site only.

NOTE: Do not use duration to code sequela of tuberculosis.

I (a) Respiratory failure J969

(b) Pneumonia J189

Code pulmonary tuberculosis as active. Do not use duration of the tuberculosis to indicate sequela.

2. B91 Sequela of acute poliomyelitis

Use this category for the classification of poliomyelitis (conditions in A800-A809) if:

a. A statement of a late effect or sequela of acute poliomyelitis is reported.

I (a) Sequela of acute poliomyelitis B91

Code sequela of acute poliomyelitis as indexed.

b. A chronic condition or a condition with a duration of one year or more that was due to the acute poliomyelitis is reported.

I (a) Paralysis - 1 year G839

(b) Acute poliomyelitis B91

Code sequela of acute poliomyelitis, since the paralysis has a duration of 1 year.

c. The poliomyelitis is stated to be by history, history, history of, old, or the interval between onset of the poliomyelitis and death is indicated to be one year or more whether or not the residual (late) effect is specified.

I (a) Old polio B91

Code old polio.

d. The poliomyelitis is not stated to be acute or active and the interval between the onset of the poliomyelitis and death is not reported.

I (a) Poliomyelitis B91

(b)

(c)

I (a) ASHD I251

(b)

(c)

II Poliomyelitis B91

I (a) Paralysis G839

(b) Polio B91

(c)

I (a) Poliomyelitis with B91 G839

(b) paralysis

(c)

3. B92 Sequela of leprosy

Use this category for the classification of leprosy (conditions in A30) if:

a. A statement of a late effect or sequela of the leprosy is reported.

b. A chronic condition or a condition with a duration of one year or more that was due to leprosy is reported.

4. B940 Sequela of trachoma

Use this subcategory for the classification of trachoma (conditions in A710-A719) if:

a. A statement of a late effect or sequela of the trachoma is reported.

I (a) Late effects of trachoma B940

b. The trachoma is stated to be healed or inactive, whether or not the residual (late) effect is specified.

I (a) Healed trachoma B940

c. A chronic condition such as blindness, cicatricial entropion or conjunctival scar that was due to the trachoma is reported unless there is evidence of active infection.

I (a) Conjunctival scar H112

(b) Trachoma B940

5. B941 Sequela of viral encephalitis

Use this subcategory for the classification of viral encephalitis (conditions in A830-A839, A840-A849, A850-A858, A86) if:

a. A statement of a late effect or sequela of the viral encephalitis is reported.

I (a) Late effects of viral encephalitis B941

Code sequela of viral encephalitis as indexed.

b. A chronic condition or a condition with a duration of one year or more that was due to the viral encephalitis is reported.

I (a) Chronic brain syndrome F069

(b) Viral encephalitis B941

Code sequela of viral encephalitis, since a resultant chronic condition is reported.

c. The viral encephalitis is stated to be ancient, by history, history, history of, old, remote, or the interval between onset of the viral encephalitis and death is indicated to be one year or more whether or not the residual (late) effect is specified.

I (a) St. Louis encephalitis 1 yr B941

Code sequela of viral encephalitis, since a duration of 1 year is reported.

I (a) Old viral encephalitis B941

Code sequela of viral encephalitis, since it is stated “old.”

d. Brain damage, cerebral fungus, CNS damage, epilepsy, hydrocephalus, mental retardation, paralysis (G810-G839) is reported due to the viral encephalitis.

I (a) Paralysis G839

(b) Viral encephalitis B941

Code sequela of viral encephalitis since paralysis is reported due to the viral encephalitis.

6. B942 Sequela of viral hepatitis

Use this subcategory for the classification of viral hepatitis (conditions in B150-B199) if:

A statement of a late effect or sequela of the viral hepatitis is reported.

7. B948 Sequela of other specified infectious and parasitic diseases
B949 Sequela of unspecified infectious and parasitic diseases

Use B948 for the classification of other specified infectious and parasitic diseases (conditions in A000-A099, A200-A289, A310-A70, A740-A799, A811-A829, A870-B09, B250-B89) and

Use B949 for the classification of only the terms “infectious disease NOS” and “parasitic disease NOS” if:

a. A statement of a late effect or sequela of the infectious or parasitic disease is reported.

b. The infectious or parasitic disease is stated to be ancient, arrested, by history, cured, healed, history, history of, inactive, old, quiescent, or remote, whether or not the residual (late) effect is specified, unless there is evidence of activity of the disease.

c. A chronic condition or a condition with a duration of one year or more that was due to the infectious or parasitic disease is reported.

I (a) Reye syndrome 1 yr G937

(b) Chickenpox B948

I (a) Chronic brain syndrome F069

(b) Meningococcal encephalitis B948

I (a) Acute and chronic UTI N390

(b) Clostridium difficile colitis B948

d. There is indication the interval between onset of the infectious or parasitic disease and death was one year or more, whether or not the residual (late) effect is specified.

8. E640-E649 Sequela of malnutrition and other nutritional deficiencies

Use Sequela Code For Categories

E640 E40-E46

E641 E500-E509

E642 E54

E643 E550-E559

E648 E51-E53 E610-E638

E56-E60

E649 E639

Use these subcategories for the classification of malnutrition and other nutritional deficiencies (conditions in E40-E639) if:

a. A statement of a late effect or sequela of malnutrition and other nutritional deficiencies (E40-E639) is reported.

I (a) Cardiac arrest I469

(b) Sequela of malnutrition E640

b. A condition with a duration of one year or more is qualified as rachitic or that was due to rickets (E55.-) is reported.

I (a) Scoliosis 3 years M419

(b) Rickets E643

9. E68 Sequela of hyperalimentation

Use this category for the classification of hyperalimentation (conditions in E67 and hyperalimentation NOS in R632) if:

a. A statement of a late effect or sequela of the hyperalimentation is reported.

b. A condition with a duration of one year or more that was due to hyperalimentation is reported.

10. G09 Sequela of inflammatory diseases of central nervous system

Use this category for the classification of intracranial abscess or pyogenic infection (conditions in G000-G009, G030-G049, G060-G069, G08) if:

a. A statement of a late effect or sequela of the condition in G000-G009, G030-G049, G060-G069, G08 is reported.

b. A condition with a duration of one year or more that was due to the condition in G000-G009, G030-G049, G060-G069, G08 is reported.

c. The condition in G000-G009, G030-G049, G060-G069, G08 is stated to be ancient, by history, history, history of, old, remote, or the interval between onset of this condition and death is indicated to be one year or more, whether or not the residual (late) effect is specified.

d. Brain damage, cerebral fungus, CNS damage, epilepsy, hydrocephalus, mental retardation, paralysis (G810-G839) is reported due to a condition in G000-G009, G030-G049, G060-G069, G08.

I (a) Hydrocephalus G919

(b) Meningitis G09

11. I690-I698 Sequela of cerebrovascular disease

Use this category for the classification of cerebrovascular disease (conditions in I600-I64, I670-I671, I674-I679) if:

a. A statement of a late effect or sequela of a cerebrovascular disease is reported.

I (a) Sequela of cerebral infarction I693

Code sequela of cerebral infarction as indexed.

b. A condition with a duration of one year or more that was due to one of these cerebrovascular diseases is reported.

I (a) Hemiplegia 1 year G819

(b) Intracranial hemorrhage I692

Code sequela of other nontraumatic intracranial hemorrhage since the residual effect (hemiplegia) has a duration of one year.

c. The condition in I600-I6400, I670-I671, I674-I679 is stated to be ancient, by history, history, history of, old, remote, or the interval between onset of this condition and death is indicated to be one year or more, whether or not the residual (late) effect is specified.

I (a) Brain damage G939

(b) Remote cerebral thrombosis I693

Code sequela of cerebral thrombosis since the cerebral thrombosis is reported as remote.

I (a) Old intracerebral hemorrhage I691

Code sequela of intracerebral hemorrhage since the intracerebral hemorrhage is stated as old.

I (a) Cerebrovascular occlusion 6 yrs I693

Code sequela of cerebrovascular occlusion since the duration is one year or more.

I (a) History of CVA 9 mos I694

Code sequela of CVA since “history of” CVA is reported.

I (a) Stroke 99 years I64

Code as I64 and do not interpret as sequela since 99 in the duration block is interpreted as unknown duration.

d. The condition in I600-I6400, and I670-I671, I674-I679 is reported with paralysis (any) stated to be ancient, by history, history, history of, old, remote, or the interval between onset of this condition and death is indicated to be one year or more whether or not the residual (late) effect is specified.

I (a) CVA with old hemiplegia I694 G819

Code sequela of CVA since it is reported with hemiplegia stated as old.

12. O970-O979 Sequela of obstetric cause

Use this category for the classification of an obstetric cause (conditions in O00-O927) if:

a. A statement of a late effect or sequela of the obstetric cause is reported.

b. A chronic condition or a condition with a duration of one year or more that was due to the obstetric cause is reported.

G. Ill-defined and unknown causes

1. Sudden infant death syndrome (R95)

Includes:

Cot death

Crib death

SDII, SID, SIDS, SUD, SUDI, SUID, SUPC Causing death at ages under 1 year

Sudden (unexpected) (unattended) (unexplained)

• death (cause unknown) (in infancy) (syndrome)

• infant death (syndrome)

• postnatal collapse

Excludes:

The listed conditions causing death at ages one year or over (R960)

Female, 6 months

I (a) Sudden death R95

Male, 3 weeks

I (a) Sudden death, cause unknown R95

(b) R97

Female, 3 months

I (a) SIDS, pneumonia R95 J189

2. Other sudden death and other unspecified cause (R960-R961, R98-R99)

Code R960-R961, R98-R99 only when:

a. A term(s) classifiable to one of these codes is the only entry (or entries) on the death certificate.

b. The only other entry on the death certificate is classifiable to R97 (cause unknown).

Female, 2 years

I (a) Sudden death R960

(b) Crib death R960

c. When more than one term classifiable to two or more of these categories is reported, code only one in this priority: R960, R961, R98, R99.

(1) Instantaneous death (R960)

Includes:

Cot death

Crib death

SDII, SID, SIDS, SUD, SUDI, SUID, SUPC Causing death at age 1 year or over

Sudden (unexpected) (unattended) (unexplained)

• death (cause unknown) (in infancy) (syndrome)

• infant death (syndrome)

• postnatal collapse

Excludes:

The listed conditions causing death at ages under one year (R95).

Male, 3 years

I (a) Sudden death, cause unknown R960

(b) R97

Female, 2 years

I (a) SIDS, pneumonia J189

(2) Death occurring in less than 24 hours from onset of symptoms, not otherwise explained (R961)

I (a) Died—no sign of disease R961

(3) Unattended death (R98)

I (a) Found dead R98

(b) Investigation pending

I (a) Found dead at foot of steps R98

(b) Natural causes

(4) Ill-defined and unspecified cause of mortality (R99)

Includes:

Bone(s) found

Dead on arrival (DOA)

Diagnosis deferred

Died without doctor in attendance

Inquest pending

Natural cause(s)

Natural causes, cause unknown

Natural causes uncertain

Natural causes undetermined

Natural causes unknown

Natural causes unspecified

Natural disease undetermined

No doctor

Pending examination (any type)

(pathological) (toxicological)

Pending investigation (police)

Skeleton

Uncertain natural causes

Undetermined natural causes

Undetermined natural disease

Undiagnosed disease

Unknown natural causes

Unspecified natural causes

Excludes:

Unknown cause (R97)

NOTE: When a term from the preceding list is reported immediately preceding or following a term from the Unknown Cause (R97) list, assign R99 only.

I (a) DOA R99

(b) Cause unknown R97

I (a) No doctor R99

(b) Pending investigation R99

I (a) Cause unknown R97

(b) Pending pathological examination R99

I (a) Natural causes, cause unknown R99

3. Unknown cause (R97)

Includes:

Cause not found Immediate cause unknown

Cause unknown No specific etiology identified

Cause undetermined No specific known causes

Could not be determined Nonspecific causes

Etiology never determined Not known

Etiology not defined Obscure etiology

Etiology uncertain Undetermined

Etiology unexplained Uncertain

Etiology unknown Unclear

Etiology undetermined Unexplained cause

Etiology unspecified Unknown

Final event undetermined ? Cause

Immediate cause not determined ? Etiology

a. Use this category for the classification of the listed terms except when the term in R97 is reported

(1) On the same line with and preceding a condition qualified as “possible,” “probable,” etc.

(2) In “Describe How Injury Occurred” (Item 43) of the death certificate.

In such cases, do not enter a code for the term in R97.

I (a) G. I. hemorrhage K922

(b) Cause unknown R97

I (a) Unknown cause R97

I (a) Intestinal obstruction K566

(b) Unknown, possibly cancer C80

I (a) Amyloidosis E859

(b) Chronic ulcerative colitis K519

(c)

II Cirrhosis of liver, cause unknown K746 R97

Place I (a) Cardiac arrest I469

9 (b) Hip fracture S720

MOD (c) Fall &W19

A II

Accident

Unknown

b. If the term in R97 is reported in Part I on the same line with and following the condition to which it applies, enter the code for unknown cause on the next due to line whether or not “cause unknown” is in parentheses beside the condition in Volume 3. Code the conditions on each of the remaining lines in Part I, if there are any, as though they had been reported on the succeeding line(s).

Female, 3 months

I (a) SIDS, cause unknown R95

(b) R97

I (a) Unknown cause R97

(b) Found dead R98

I (a) Unknown R97

(b) Known to have had ASHD I251 J42

I (a) Gastric ulcer, cause unknown K259

(b) Rheumatoid arthritis R97

SECTION V - EFFECTS OF EXTERNAL CAUSE OF INJURY AND EXTERNAL CAUSES OF INJURY AND POISONING

In ICD-10, the Nature of Injury Chapter (XIX) is part of the main Classification but certain effects of external causes are classified in Chapters I-XVIII. The external cause codes (Chapter XX) are intended for use, where relevant, to identify the external cause of conditions classifiable to Chapters I-XVIII, as well as to Chapter XIX. While not all external causes will have a corresponding code in Chapter XIX, an external cause code is required when a code from Chapter XIX is applicable.

A. External cause code (E-Code) concept

An external cause of injury may be classified to Accidents (V01-X59), Intentional self harm (X60-X84), Assault (X85-Y09), Event of undetermined intent (Y10-Y34), Legal intervention and operations of war (Y35-Y36), Complications of medical and surgical care (Y40-Y84), and Sequela of external causes (Y85-Y89). When unspecified, assume all external cause one-term entities to be accidental unless the External Causes of Injury Index provides otherwise.

The objective in assigning the external cause codes is to combine into the entity being coded any related entries on the record that will permit the assignment of the most specific external cause codes in accordance with the intent of the certifier. After the determination of the most specific external cause code is made, enter this code where it is first encountered on the record. Do not repeat the same external cause code when it is reported on other lines. When more than one external cause is reported, code each external cause code where it is first encountered on the certificate.

The death certificate provides a specific place for information concerning the external cause of injury that is usually entered on the lines below the line labeled “Part II.” However, a description of the external cause is reported frequently in Part I and may be repeated in the space provided for this information.

When the manner of death block is marked as Homicide but the certifier specifies Accident elsewhere on the certificate, code as Accident. The definition of homicide as "death at the hands of another" may lead certifiers to mark Homicide in the checkbox when really the death itself was unintentional. For all other manners of death, if there is more than one reported, code as could not be determined.

When such statements as: “jumped or fell,” “don’t know,” “accident or suicide,” “accident or homicide,” “undetermined,” or “open verdict” are reported, code the external cause as “undetermined.” The “undetermined” categories include self-inflicted injuries, except poisoning, when not specified whether accidental or with intent to harm.

1. Use of Index

ICD-10 provides separate indexing in Volume 3, Section II for the external causes of injury, with frequent references to Volume 1. The External Causes of Injury Index provides a double axis of indexing — descriptions of the circumstances under which the accident or violence occurred and the agent involved in the occurrence. Usually, the “lead terms” in the External Causes of Injury Index describe the circumstances of the injury with a secondary (indented) entry naming the agent involved.

Fall from building W13

Locate the E-code for “fall”:

Fall, falling

- from, off

- - building W13.-

2. Use of Tabular List

After locating the external cause code in the Index, always refer to Volume 1 since certain external cause codes for transport accidents require a fourth character not provided for in the Index. When ICD-10 provides a fourth character subcategory for an external cause code, always code the fourth character.

Fell from boat V929

Locate the E-code for “fall”:

Fall

- from

- - boat, ship, watercraft NEC (with drowning or submersion) V92.-

In Volume 1, the fourth character describes the type of boat. Code the fourth character “9,” unspecified watercraft.

The Classification provides a fourth character for use with categories W00-Y34, except Y06.- and Y07.-, to identify the place of occurrence of the external cause. NCHS uses a separate field for this purpose. Only the three-character category codes are assigned in multiple cause coding.

House fire X00

Locate the E-code for “House fire”:

House Fire (uncontrolled) X00.-

In Volume 1, a fourth character identifying the place of occurrence is required. Assign code 0 (home) to the place of occurrence variable in the field provided for this variable.

3. Place of occurrence of external cause

Enter a one-character place of occurrence code (0-9), for external causes of injury classifiable to W00-Y34, except Y06.- and Y07.-, if the effects of the external cause are classifiable to Chapter XIX. Do not enter a place code for external causes classifiable to any other external cause code. Use only the information reported in the medical certification section of the death certificate or additional information (AI) to determine the place code. Refer to Appendix D for the list of place of occurrence codes.

4. Manner of death (Item 37) on death certificate

a. Affecting multiple cause codes

(1) When separate check boxes for indicating whether an external cause was accidental, suicidal, homicidal, undetermined, or pending investigation appear on the medical certification form, treat the check box entry as a one-term entity.

(2) When “accident,” “pending,” “unknown,” or “undetermined” is written in the “check box” or is one of the items checked and no condition is coded to Chapter XIX, disregard the check box entry for assignment of codes.

(3) When “suicide” or “homicide” is written in the “check box”, or is one of the items checked and no condition is coded to Chapter XIX, assign the appropriate external cause code preceded by Injury NOS, T149.

(4) When “unknown” or “open verdict” is written in the check box and there is a condition(s) coded to Chapter XIX, code the external cause to the appropriate “event of undetermined intent” category.

(5) When “pending,” “pending investigation,” “deferred,” or “unclassified” is reported in the check box and there is a condition(s) coded to Chapter XIX, code the external cause as indexed.

(6) Enter a code for an entry in a check box for “natural cause” only if this is the only codable entry on the certificate or the only other codable entry is “unknown cause” (R97).

b. As a separate variable

Enter an alpha character manner of death code (N, A, S, H, P, or C) in the appropriate data position for any entry in the manner of death check box. Use only the information reported in the manner of death box to assign the code.

Code the manner of death as:

Natural....................................... N

Accident..................................... A

Suicide........................................ S

Homicide.................................... H

Pending Investigation.................. P

Could not be determined.............. C

Blank.......................................... Blank

5. Nature of injury and external cause code lists

Since certain entities state or imply cause (E-code) and effect (N-code), ICD-10 provides both N-codes and E-codes for many terms. Determination must be made whether to code nature of injury code only, external cause code only, or both nature of injury and external cause codes for such terms. Use the following lists as guides in classifying these terms. When ICD-10 provides a nature of injury code for an entity that does not appear on either list, use the nature of injury code only.

The E-code is only coded the first time external information is mentioned. A term requiring a N-code is coded each time it is reported.

Nature of injury code only (N-Code)

Allergy Intoxication when due to a

Anaphylactic reaction drug

Anaphylactic shock Lacerations

Anaphylaxic, anaphylaxis Lack of care

Anoxia Mucus plug

Bezoar Multiple injuries

Burns Polypharmacy (when it means

Cremation drug poisoning)

Crushed Scald

Decapitation Severed

Deceleration injury Sharp force injury

Drug NOS or named drug Smoke

(when it means drug poisoning) Starvation

Drug synergism Trauma NOS (any site)

Exhaustion Traumatic

Fracture Traumatic death

Inattention at birth Traumatic injury (any site)

Incineration Traumatism

Injury NOS (any site) Wound (penetrating)

External cause code only (E-code)

Abandonment Explosive blasts to site(s) Inhalation

Accident, accidental Fall Physical violence

Arson Fight Projectile

Assault Fire Reaction of drug with a

Beaten Flood reported complication

Blow to any site Foreign body Striking any site

Blunt force NOS Heat Suicide, suicidal

Blunt impact NOS Hitting any site

Conflagration Homicide, homicidal

Desertion Hot environment

Excessive heat Hot weather

Explosion Impact

Entities Requiring nature of injury and external cause codes on the same line (N\E Codes)

Abuse (child) (elder) (spousal) Hypothermia

Airway obstruction by foreign Immersion

body Impact injury (any site)

Alcohol intoxication (any term Impact to a site (any)

meaning intoxication) Incised (wound)

Anastomotic leak Ingestion of foreign body

*Asphyxia Inhalation injury (any)

*Aspiration *Inhalation of foreign body

Battered child (syndrome) Lightning (struck by)

Bite Mangled

Blunt blow to a site Mechanical trauma

Blunt force injury (any site) Overdose (of drug or alcohol)

Blunt force to a site (any) Overheated

Blunt impact to a site (any) Overexertion

Blunt injury (any site) Poisoning (by substance)

Blunt trauma (any site) Pulled trigger

Bullet (to site) Puncture, punctured (any site)

Bullet wound Puncture wound

Child neglect Radiation burns

Choking on foreign body Rape

Crushed by specified object Razor cut

Cut Shoot, shooting, shot (to site)

Drowning Shotgun blast (to site)

Electrocution Slash, slashed (any site)

Electrical burns Smothered

Electrical shock Snake bite

Exposure (to element) (cold, heat) Stab

Firearm (any type) (discharge) Sting

Flame burn Strangulation

Foreign body in any site Submersion

Freezing, froze, frostbite Suffocation

Got too hot Sunstroke

Gun went off Suspension, suspended

Gunshot (to site) Swallowed object

Gunshot wound Toxicity (of substance)

Hanging (by neck) Vehicular trauma

Heat exhaustion Weapon wound

Heat stress .22, .32 or any caliber

Heat stroke

(* This does not apply when certain localized effects result from asphyxia, aspiration, or inhalation. Refer to Section V, Part O.)

B. Placement of nature of injury and external cause codes

When a nature of injury code and an external cause code are required for an entity, enter the nature of injury code followed by the external cause code on the same line.

Place I (a) Gunshot wound of chest S219 &W34

9 (b)

(c)

MOD II

Accident

Since “gunshot wound” requires a nature of injury and an E-code, enter on I(a) the nature of injury code for wound of chest followed by the most specific E-code for gunshot, accidental. Code place of occurrence as 9 (unspecified). Code manner of death as A (accident).

When entries requiring nature of injury codes and external cause codes are reported on the same line in Part I, code the first nature of injury code followed by the most specific external cause code; then code any remaining conditions for the line in the order indicated by the certifier.

Place I (a) Laceration of throat S118

9 (b) Dog bite of shoulder, S410 &W54 T111 S119

Code the nature of injury code only for I(a). On I(b), code the nature of injury code for “bite of shoulder” followed by the E-code for dog bite followed by the remaining nature of injury codes for “bite arm and neck.” Code place of occurrence as 9 (unspecified).

Place I (a) Fracture skull S029

9 (b) Fell from window, crushed S280 &W13 S381

I(a) requires a nature of injury code only. I(b) requires both nature of injury and E-code since the external cause and injuries are reported on this line. Code first nature of injury code followed by the external cause code, followed by the remaining nature of injury codes. Code place of occurrence as 9 (unspecified).

Place I (a) Renal failure N19

0 (b) Injury kidney, liver and S370 &W11 S361 S360

Code I(b) injury kidney followed by external cause code for the fall, followed by the remaining injuries. Code place of occurrence as 0 (home).

Place I (a) Cerebral laceration & contusion S062

9 (b) Blow to right temporal area &X599

Code I(a) to the nature of injury code only, and I(b) to the external cause code only. Code place of occurrence as 9 (unspecified).

In Part II, code each entry in the same order as entered on the certificate. For entities requiring both nature of injury and external cause codes, enter the nature of injury code followed by the external cause code. Enter the information recorded in the special spaces that have been provided on the medical certification form for recording information about external causes of injury following any codes that are applicable to Part II.

Place I (a) Crushed chest S280

9 (b) Broken rib S223

(c)

II Fracture hip and arm S720 T10 &W24

43	Run over by a forklift

In Part II, code each entry in the order entered on the certificate. Code place of occurrence as 9 (unspecified).

Place I (a) Subdural hematoma S065

9 II Blunt impact injury to head S099 &Y00

MOD

Homicide

43	Struck on head with a blunt object by another person

Since the entry in Part II requires both nature of injury and external cause codes, enter the nature of injury code followed by the most specific external cause code. Code place of occurrence as 9 (unspecified).

Place I (a) Head wound S019

9 II &W34 S062 S019

MOD

Accident

43	Cerebral laceration, GSW of head

Code external cause code first in Part II since manner of death box requires an external cause code. Code place of occurrence as 9 (unspecified).

C. Use of ampersand

1. Use an ampersand to identify the following

a. The most specific external cause code causing injuries or poisoning.

b. Certain localized effects of poisonous substances (X45-X49) or aspiration (W78,W79, W80) when classifiable to Chapters I-XVIII.

c. Ampersand the E-code for aspiration (W78-W80) anytime it is reported.

Place I (a) Aspiration T179 &W78

0 (b) Vomitus

II Fx Hip Fall at home S720 &W19

Ampersand both the E-code for aspiration and the E-code for fall at home.

Exceptions to c:

1. When reported due to:

• nature of injury codes

• medical and surgical care

• other external causes

2. When a nature of injury code other than T179 is reported as the first condition on the lowest used line in Part I.

Place I (a) Aspiration of vomitus T179 W78

0 (b) Fx hip S720

II Fall at home &W19

Do not ampersand the E-code for aspiration since both Exception 1 and 2 apply.

2. More than one external cause reported

a. In determining the most specific external cause code, consider all of the information reported on the record. If two or more external causes are reported and the nature of injuries and/or the order in which the conditions are reported indicates that one of the external causes led to the condition that terminated in death, precede the code for this external cause by an ampersand. If no determination can be made, precede the code for the first mentioned external cause with an ampersand.

Place I (a) Aspiration of vomitus T179 W78

9 (b) Internal chest injury S279

The order in which the conditions are reported indicates that the fall down stairs led to aspiration; therefore, the ampersand precedes the code for this external cause.

Place I (a) Gunshot wound of head S019 &X95

9 (b) Stab wound of chest S219 X99

MOD II

Homicide

The order in which the external causes are reported does not indicate which event occurred first; therefore, precede the code for the gunshot wound with an ampersand since it is the first external cause reported.

Place I (a) Head trauma S099

9 II Alcohol intoxication, auto accident T519 X45 &V499

Precede the code for the auto accident with an ampersand. Alcohol intoxication did not cause the head trauma.

Place I (a) Positional asphyxia complicating mixed drug (morphine T71 &W84 T402 X44 T424

9 (b) and temazepam) intoxication

MOD II Obesity and obstructive sleep apnea E669 G473 J969 T402 T424

Accident

Positional respiratory compromise after self-administering morphine and temazepam

Code I(a) as indexed, preceding the W84 with an ampersand since it is the first mentioned e-code. Assign the N and E-codes for the named drug poisoning on line I(a). In Part II, code the diseases as indexed and assign the nature of injury codes for the drugs repeated in the How Injury Occurred block.

b. When alcohol intoxication (or any term meaning intoxication) is reported with another external cause other than aspiration, precede the code for the first mentioned external cause with an ampersand.

When alcohol intoxication is reported with drugs, refer to Section V, Part Q, 4, Poisoning by alcohol and drugs.

When alcohol intoxication is reported with exposure or hypothermia, refer to Section V, Part L, 2, Exposure, cold exposure and hypothermia.

Place I (a) Head trauma S099

9 (b) Auto Accident &V499

Precede the code for the auto accident with an ampersand since it is the first external cause reported.

Place I (a) Drowning T751 &W74

9 (b) Alcohol intoxication T519 X45

II Drinking heavily F101

Precede the code for the drowning with an ampersand since it is the first external cause reported. Code Part II as indexed.

Place I (a) Alcohol intoxication and hip fx T519 &X45 S720

9 II Fall while intoxicated W19 T519

Precede the code for the alcohol intoxication with an ampersand since it is the first external cause reported.

Place I (a) Positional asphyxia in the setting of acute ethanol T71 &W84

9 (b)intoxication T510 X45

Precede the code for the positional asphyxia with an ampersand since it is the first external cause reported.

D. Certifications with mention of nature of injury and without mention of external cause

All certifications that have an entry classifiable to Chapter XIX must have an external cause code. When only one type of injury is reported without indication of the external cause and the External Cause Index provides a code for this type of injury, code accordingly. If the External Cause Index does not provide a code for the type of injury, code to Accident, unspecified (X599). When no external cause is reported and the external cause code must be assumed, code the external cause code as the last entry in Part II.

Place I (a) Crushed chest S280

9 II &X599

Code Crushed (accidentally), X599 as indexed.

Place I (a) Fracture of hip and arm S720 T10

9 II &X590

Code Fracture (circumstances unknown or unspecified), X590 as indexed.

Place I (a) Penetrating wound of abdomen S318 S219

9 (b) and chest

II &X599

Code Wound (accidental) NEC, X599 as indexed.

If different types of injuries are reported without indication of the external cause, use the injury reported in the lowest due to position to assign the appropriate external cause code for this injury. If more than one injury is reported on the lowest line, assign the appropriate external cause code for the first mentioned injury.

Place I (a) Brain injury S069

9 (b) Fracture of skull S029

II &X590

Code Fracture (circumstances unknown or unspecified), X590.

Place I (a) Fracture of hip S720

9 (b) Crushing hip injury S770

II &X599

Code Crushed (accidentally), X599.

Place I (a) Cerebral concussion and S060 S062

9 (b) laceration of brain

II &X599

Concussion is not indexed in External Cause Index. Code to Accident, unspecified, X599.

These generalizations do not apply if the place of occurrence of the injury was highway, street, road, or alley. Refer to instructions for transport accidents in Section V, Part J.

Implied site of injury

Relate most injuries of an unspecified site to a condition of a specified site, whether or not qualified as generalized, multiple, or stated plural, following general instructions for relating disease conditions.

Exceptions:

Do not relate

Injury(ies) (generalized) (internal) (multiple)

Trauma(s) (generalized) (internal) (multiple)

Wound(s) (generalized) (internal) (multiple)

Place I (a) Crushed skull with multiple fractures S071 S029

9 II &X599

Code crushed skull followed by multiple skull fractures relating the injury of unspecified site to the site of the injury that is reported on the same line. Since there is no external cause reported, code Crushed (accidentally) as indexed in Part II.

Place I (a) Fractured neck and contusions S129 S109

9 II &X590

Code fractured neck followed by neck contusion relating the injury of unspecified site to the site of the injury that is reported on the same line. Since there is no external cause reported, code Fracture (circumstances unknown or unspecified) as indexed in Part II.

Place I (a) Fracture of hip S720

9 (b) Crushing injury S770

II &X599

Code crushing injury hip since there is only one site reported either on the line above or below the fracture. Since there is no external cause reported, code Crushed (accidentally) as indexed in Part II.

Place I (a) Fracture of skull with generalized trauma S029 T07

9 II &X590

Code the generalized trauma as indexed. Do not relate to the site of the injury reported on the same line with it. Since there is no external cause reported, code Fracture (circumstances unknown or unspecified) as indexed in Part II.

Place I (a) Skull fracture S029

9 (b) Wound T141

II &X599

Code I(b) to Wound as indexed. Do not relate to the site of the fracture reported on the upper line. Since there is no external cause reported, code Wound (accidental) NEC, X599 as indexed in Part II.

E. Conditions qualified as traumatic

1. Some conditions are indexed directly to a nontraumatic category but the Classification also provides a traumatic code. Consider these conditions to be traumatic and code as traumatic:

a. When they are qualified as “traumatic”

b. Or they are reported on the certificate with:

• Injury or trauma (any specified type or site)

• An external cause

• The Manner of Death is Accident, Homicide, Suicide, Pending Investigation or Undetermined

Exception:

Do not apply this instruction if:

• the condition is reported due to a nontraumatic condition

• W78-W80 is the only external cause reported

• poisoning is reported

Place I (a) Pneumothorax S270

6 (b) Fracture rib S223

II &X590

Place of injury- Factory

Since pneumothorax is reported on the certificate with an injury, code pneumothorax as traumatic.

Place I (a) Cerebral hemorrhage S062

9 (b)

(c)

MOD II &X599

Accident

Consider cerebral hemorrhage to be traumatic since Accident is reported in the Manner of Death box.

I (a) Cardiorespiratory failure R092

(b) Intracerebral hemorrhage I619

MOD II

Accident

Since intracerebral hemorrhage is reported due to a disease condition, code as nontraumatic. Do not enter an E-code for Accident reported in the check box since no condition is coded to Chapter XIX.

Place I (a) Subarachnoid hemorrhage S066

9 (b) Fall &W19

MOD II

Natural

Code subarachnoid hemorrhage as traumatic since it is reported on the certificate with an external cause, disregarding Natural in the Manner of Death box.

Exceptions:

a. Code emphysema, encephalitis, and meningitis to the nature of injury code only when they are stated to be "traumatic" or are reported due to or on the same line with an injury or external cause.

Place I (a) Emphysema T797

9 (b) Injury chest S299

Code I(a) emphysema, traumatic since the condition is reported due to an injury.

Place I (a) Internal injury T148

9 (b) Fall from ladder &W11

II Meningitis G039

Do not code the meningitis as traumatic since it is not reported due to or on the same line with an injury or external cause. Code place of occurrence as 9 (unspecified).

b. Code the following terms to the traumatic category only when stated “traumatic:”

blindness (H540-H549)

epilepsy (G400-G409)

gastrointestinal hemorrhage (any K922)

pneumonia (classifiable to J120-J168, J180-J189, J690, J698)

Place I (a) Pneumonia J189

9 (b) Fracture hip S720

II Fall &W19

Code I(a) pneumonia as indexed since it is not reported as traumatic.

I (a) Traumatic epilepsy T905

(b) Head injury T909

Code epilepsy to the nature of injury code since it is stated traumatic.

c. When the traumatic form of a condition is classified to Chapters I-XVIII, code as traumatic only when stated to be “traumatic”

Place I (a) Cardiac arrest I469

9 (b) Organic brain syndrome F069

(d) Fall &W19

Code organic brain syndrome as indexed since it is not stated “traumatic.”

2. When a condition of a specified site is stated to be traumatic but there is no provision in the Classification for coding the condition as traumatic, code to injury unqualified of the site.

Place I (a) Traumatic cerebral thrombosis S069

9 (b) Fall &W19

Code Injury, cerebral.

3. When a condition that does not indicate a specified site is stated to be traumatic, but there is no provision in the Classification for coding the condition as traumatic code trauma unspecified and the condition separately.

Place I (a) Traumatic coma T149 R402

9 (b) Fall &W19

Code trauma unspecified and coma separately.

4. Traumatic hemorrhage (T148, T149)

Internal 1 Due to or on same line Code the hemorrhage to T148,

hemorrhage with injury (any site) internal injury NOS

NOS

Hemorrhage 2 Due to injury of a Relate the hemorrhage to the

NOS specified site site of the specified injury

3 Due to injury NOS or Code the hemorrhage to T149,

multiple injuries NOS injury NOS

4 Due to injury of multiple Relate the hemorrhage to site

specified sites of the first mentioned specified

injury

5 Due to internal injury Code the hemorrhage to T148,

NOS or internal injuries internal injury NOS

NOS

6 On same line with Relate the hemorrhage to the

injury of site site of the specified injury

7 On same line with Code the hemorrhage to T149,

injury of multiple injury NOS

specified sites

8 On same line with Code the hemorrhage to T148,

internal injury NOS or internal injury NOS

internal injuries NOS

9 Due to and on same Relate the hemorrhage to the

line with injuries of site of the injury that is entered

different specified sites on the same line with

hemorrhage

Instruction

Number

Place I (a) Internal hemorrhage T148 1

9 (b) Crushed thorax S280

(c)

II &X599

Place I (a) Hemorrhage S799 2

9 (b) Fracture of femur S729

(c)

II &X590

Place I (a) Hemorrhage S299 2

9 (b) Laceration of chest S219

(c)

II &X599

Place I (a) Hemorrhage T149

9 (b) Multiple injuries T07 3

(c)

II &X599

Place I (a) Hemorrhage S299

9 (b) Injury of chest, lung and S299 S273 S223 4

II &X599

Place I (a) Contusion chest with S202 S299

9 (b) hemorrhage 6

(c)

II &X599

Place I (a) Laceration of liver, lung, S361 S273 S360 T149

9 (b) & spleen with hemorrhage 7

(c)

II Fracture rt. femur S729 &X599

Place I (a) Cerebral contusion S062

9 (b) with hemorrhage 9

II &X599

F. Assumption of nature of injury code

When an external cause is reported on a certificate without a nature of injury code, assign both a nature of injury and an external cause code. Assume the nature of injury to be Injury NOS, T149 and place it preceding the external cause code.

Place I (a) Respiratory failure J969

9 (b) Fire T149 &X09

I(b) is an external cause code only. Since there is not a nature of injury reported on the certificate, code nature of injury T149 preceding the external code for fire.

Place I (a) Subarachnoid hemorrhage I609

9 (b) Stroke I64

Do not code the hemorrhage on I(a) as traumatic since it is reported due to a nontraumatic condition. I(c) is an external cause code only and there is not a nature of injury reported on the certificate. Code nature of injury T149 preceding the external code for fall.

Place I (a) Struck by falling tree &W20

9 II Head wound S019

I(a) is an external cause code only. Since there is a nature of injury on the certificate, do not code T149 preceding the external code.

Place I (a) Struck by falling tree T149 &W20

9 II Respiratory failure J969

I(a) is an external cause code only. Since there is not a nature of injury on the certificate, code T149 preceding the external code.

Exceptions:

1. When conditions classified to categories A000-R99 are reported due to “second hand smoke”, code the “second hand smoke” to X49.

I (a) Pulmonary emphysema J439

(b) Second hand smoke X49

I (a) Lung cancer C349

(b) Second hand smoke X49

I (a) Cardiac arrest I469

(b) Second hand smoke X49

2. Anthrax is reported with accident, suicide, homicide or undetermined

When anthrax (A220-A229) is reported with accident, suicide or homicide anywhere on the record (including in the check box) or undetermined in the check box only, code the anthrax as indexed and code the external cause code as:

• Accident specified (X58)

• Suicide specified (X83)

• Homicide specified (Y08)

• Undetermined specified (Y33)

Anthrax designated as an act of terrorism is classified to U016.

MOD I (a) Inhalation anthrax A221

H II Y08

Homicide

Code I(a) as indexed under Anthrax, inhalation. Code an E-code only in Part II for homicide based upon the check box entry. Also enter a H for Homicide in the Manner of Death item.

I (a) Anthrax A229

(b) Homicide Y08

Code I(a) as indexed. Code an E-code only on I(b); do not assume an injury code.

3. When conditions in J680-J709 are reported due to an external cause not considered to be medical or surgical care, refer to Section V, Part O, Guides for differentiating between effects of external causes classifiable to Chapters I-XVIII and Chapter XIX.

4. If a pathological fracture and an external event are reported, no assumption of a nature of injury code is required.

G. Multiple injuries (T00-T07 )

When injury (of a site) or specified type of injury (of a site) is:

Stated as Code as indexed under

Bilateral Injury (or specified type of injury), site,

bilateral

Both Injury (or specified type of injury), site,

both

Multiple Injury (or specified type of injury), site,

multiple

Do not consider the plural form of injury or the plural form of a site to indicate multiple. Do not consider “right and left” as bilateral or both.

Examples of injuries:

1. Fracture of both hips T025

Fracture

- hip

- - both T025

2. Fracture of hips S720

Fracture

- hip S720

3. Multiple fractures of ribs S224

Fracture

- rib

- - multiple S224

4. Fractures of ribs S223

Fracture

- rib S223

5. Multiple wounds of lower limb T013

Wound

- limb

- - lower NEC

- - - multiple sites T013

1. Multiple injuries Followed by specified Code T07 and the specified

type(s) of injuries injuries

2. Multiple injuries Followed by specified Code multiple injuries by

site(s) site(s) only

3. Single site Reported on same line Code the specified types of

with multiple types of injuries of the reported site

injuries

4. More than one site Reported on same line Code the specified type of

with multiple types of injury immediately

injuries preceding the reported sites

to the sites code all other

injuries to the NOS code

1. Place I (a) Multiple injuries with T07 S029 S062

9 (b) fracture skull and

II &X599

2. Place I (a) Multiple injuries - head, neck, chest S097 S197 S297

II &X599

3. Place I (a) Fracture, laceration and contusion T12 T131 T130

9 (b) of leg

4. Place I (a) Contusions, lacerations, fracture of trunk T140 T141 T021 T142

9 (b) and extremities

II &X599

H. Burns: multiple degrees of burns/percentage of body surface burned

1. When multiple degrees of burns are reported, with or without mention of sites, code the most severe degree only.

Place I (a) 2^nd and 3^rd degree burns T203 T213

0 (b) of face, chest wall and abdomen

(c)

MOD II &X00

Accident

home

house fire

Code 3^rd degree burns of each site reported.

Place I (a) 2^nd and 3^rd degree burns T303

9 (b)

(c)

II &X09

Code 3^rd degree burns of unspecified body region.

2. When a percentage of burns or a percentage of body (entire, total) burns is reported, code to the percentage.

Place I (a) Burns of 50% of T315

9 (b) body surface

(c)

MOD II &X06

Accident

clothing caught on fire

Code burns involving 50-59% of body surface.

3. When specified degrees of burns are reported with the percentage of body surface involved, code only the percentage of body surface involved.

Place I (a) 30-40%, 2^nd and 3^rd degree burns of body T314

0 (b)

(c)

II House fire &X00

Code burns involving 40-49% of body surface.

4. When a percentage of burns of specified sites is reported, code to burn of site(s) involved.

Place I (a) Burns, 76% of face, anterior trunk, and T200 T210 T300

8 (b) extremities

(c)

MOD II &X00 T300

Accident

burned in fire in abandoned shack

Code unspecified degree burns of each site reported. In Part II, code burned as burn of unspecified body region, unspecified degree.

I. Specified types and sites of injuries

1. When specified types of injuries of sites are reported, code to site only. Do not use Index entries of “specified type NEC” or “specified NEC” (usually .8) .

Place I (a) Impact injury, upper arm S499 &X599

Indexed as:

Injury

- arm NEC T119

- - upper S499

- - - specified NEC S498

Place I (a) Blunt injury, trunk T099 &X599

Indexed as:

Injury

- trunk T099

- - specified type NEC T098

2. When specified sites of injuries are reported, do not use Index entries of “specified type NEC” or “specified NEC”. Use only if indexed as “specified site NEC” or “specified part NEC.”

Place I (a) Fracture third cervical vertebra S129

9 (b) Fall &W19

Indexed as:

Fracture

- vertebra T08

- - cervical (teardrop) S129

- - - specified NEC S122

Place I (a) GSW right side of neck S118 &W34

Indexed as:

Wound

- neck S119

- - specified part NEC S118

J. Transportation accidents (V01-V99)

The main axis of classification for land transports (V01-V89) is the victim’s mode of transportation. The vehicle of which the injured person is an occupant is identified in the first two characters since it is seen as the most important for prevention purposes.

Definitions and examples relating to transport accidents are in Volume 1, Chapter XX. Refer to these definitions when any means of transportation (aircraft and spacecraft, watercraft, motor vehicle, railway, other road vehicle) is involved in causing death.

For classification purposes, a motor vehicle not otherwise specified is NOT equivalent to a car. Motor vehicle accidents where the type of vehicle is unspecified are classified to V87-V89.

A vehicle not otherwise specified is NOT equivalent to a motor vehicle unless the accident occurred on the street, highway, road(way), etc. Vehicle accidents where the type of vehicle is unspecified are classified to V87-V89.

Additional information about type of transports are given below

(1) Car (automobile) includes blazer, jeep, minivan, sport utility vehicle

(2) Pick-up truck or van includes ambulance, motor home, or truck (farm) (utility)

(3) Heavy transport vehicle includes armored car, dump truck, fire truck, panel truck, semi, tow truck, tractor trailer, 18-wheeler

(4) A special all-terrain vehicle (ATV) or motor vehicle designed primarily for off-road use includes dirt bike, dune buggy, four-wheeler, go cart, golf cart, race car, snowmobile, three-wheeler

(5) Motor vehicle includes passenger vehicle (private), street sweeper

1. Use of the Index and Tabular List

The Classification provides a Table of land transport accidents in Volume 3,

Section II. This table is referenced with any land transport accident if the mode of transport is known. Since the Index does not always provide a complete code, reference to Volume 1, Chapter XX is required.

For V01-V09, the fourth character indicates whether a pedestrian was injured in a nontraffic accident, traffic accident, or unspecified whether traffic or nontraffic accident.

For V10-V79, the fourth character represents the status of the victim, i.e., whether the decedent was driver, passenger, etc. For each means of transportation, there is a different set of fourth characters. Each means of transportation is preceded by its set of fourth characters in Volume 1.

• Car overturned, killing driver V485

In the Index refer to:

Overturning

- transport vehicle NEC (see also ) V89.9

Accident

- transport (involving injury to) (see also ) V99

In the Table of land transport accidents, select the intersection of:

Under Victim and mode of transport, select
Occupant of:

- car (automobile)

Under In collision with or involved in: select
Noncollision transport accident

The code is V48.-. From Volume 1 the fourth character is 5, driver injured in traffic accident.

• Auto collision with animal V409

In the Index refer to:

Collision (accidental) NEC (see also ) V89.9

Accident

- transport (involving injury to) (see also ) V99

In the Table of land transport accidents, select the intersection of:

Under Victim and mode of transport, select
Occupant of:

- car (automobile)

Under In collision with or involved in: select
Pedestrian or animal

The code is V40.-. From Volume 1, determine the fourth character is 9, unspecified car occupant injured in traffic accident.

2. Classifying accidents as traffic or nontraffic.

If an event is unspecified as to whether it is a traffic or nontraffic accident, it is assumed to be:

a. A traffic accident when the event is classifiable to categories V02-V04, V10-V82 and V87.

b. A nontraffic accident when the event is classifiable to categories V83-V86. These vehicles are designed primarily for off-road use.

c. Consider category V05 to be unspecified whether traffic or nontraffic if no place is indicated or if the place is railroad (tracks).

d. Consider category V05 to be traffic if place is railway crossing.

e. Consider accidents involving occupants of motor vehicles as traffic when the place is indicated or if the place is railroad (tracks).

I (a) Laceration lung S273

(b)

MOD II

Accident

Truck struck bridge

Driver

Code to occupant of pick-up truck or van injured in collision with fixed or stationary object, driver. When a motor vehicle strikes another vehicle or object, assume the collision occurred on the highway unless otherwise indicated.

I (a) Fractured skull S029

(b)

MOD II &V866

Accident

Farm

Dune buggy overturned-passenger

Code to passenger of all-terrain or other off-road motor vehicle injured in nontraffic accident.

I (a) Drowning T751 &V863

MOD II

Accident

Snowmobile ran off road and went into pond

Code to unspecified occupant of all-terrain or other off road motor vehicle injured in traffic accident. Code as traffic accident since the accident originated on the road.

3. Status of victim

a. General coding instructions relating to transport accidents are in Volume 1, Chapter XX. Refer to these instructions for clarification of the status of the victim when not clearly stated.

I (a) Multiple internal injuries T065

(b) Crushed by car T147 &V031

Code to pedestrian injured in collision with car, pick-up truck or van, traffic. Refer to Volume 1, Chapter XX, instruction 3, Crushed by car. The victim is classified as a pedestrian. Refer to Table of land transport accidents. Victim and mode of transport, pedestrian, in collision (with) car. Refer to Volume 1 for fourth character.

b. In classifying motor vehicle traffic accidents, a victim of less than 14 years of age is assumed to be a passenger provided there is evidence the decedent was an occupant of the motor vehicle. A statement such as “thrown from car,” “fall from,” “struck head on dashboard,” “drowning,” or “carbon monoxide poisoning” is sufficient.

Female, 4 years old

I (a) Fractured skull S029

(b) Struck head on windshield when car &V476

Code to car occupant injured in collision with fixed or stationary object, passenger (V476).

c. When transport accident descriptions do not specify the victim as being a vehicle occupant and the victim is described as:

pedestrian versus (vs) any vehicle (car, truck,

versus (vs) etc.)

any vehicle (car, truck, versus (vs) pedestrian

etc.) versus (vs)

classify the victim as a pedestrian (V0l-V09).

4. Coding categories V01-V89

a. When drowning occurs as a result of a motor vehicle accident NOS, code as noncollision transport accident. The assumption is the motor vehicle ran off the highway into a body of water. If drowning results from a specified type of motor vehicle accident, code the appropriate E-code for the specified type of motor vehicle accident.

I (a) Drowning T751 &V589

MOD II

Accident

Street

Truck accident

Refer to Table of land transport accidents. Code to occupant of truck injured in noncollision transport accident, unspecified.

I (a) Drowning T751 &V435

MOD II

Accident

Street

Driver-2 car collision

Refer to Table of land transport accidents. Code to occupant of car injured in collision with car, driver.

b. When falls from transport vehicles occur, apply the following instructions:

(1) Consider a transport vehicle to be in motion unless there is clear indication the vehicle was not in transit. Refer to Table of land transport accidents, specified type of vehicle reported, noncollision. Refer to Volume 1 for appropriate fourth character.

I (a) Multiple injuries T07

MOD II &V583

Accident

Home

Fell from truck in driveway

Refer to Table of land transport accidents under Victim and mode of transport. Select occupant of pick-up truck, noncollision transport accident, (V58.-). Refer to Volume 1 for fourth character and select 3, unspecified occupant of pick-up truck, nontraffic accident.

(2) Consider statements like these as stationary:

(a) Coded as transports (most often with 4th character .4)

alighting leaving

boarding exiting

entering getting in or out of vehicle

(b) Coded as fall

stationary

parked

not in transit

not in motion

I (a) Head injury S099

MOD II &V784

Accident

Street

Fell alighting from bus

Refer to Table of land transport accidents under Victim and mode of transport. Select occupant of bus, noncollision transport accident, (V78.-). Refer to Volume 1 for fourth character and select 4, person injured while boarding or alighting.

I (a) Head injury S099

MOD II &V892

Accident

Street

Fell on curb as he was exiting his daughter’s vehicle

Refer to Table of land transport accidents under Victim and mode of transport. Select occupant of motor vehicle (traffic), noncollision transport accident (V892).

Place I (a) Head injury S099

MOD II &W17

Accident

Street

Fell from parked car

Code as indexed under Fall, from, vehicle, stationary (W17).

5. Additional examples

I (a) Fractures of ribs S223

(b)

(c)

MOD II &V234

Accident

Driver of motorcycle that collided with parked taxicab

Code to motorcycle rider injured in collision with car, pick-up truck or van, driver (V234).

I (a) Third degree burns T303

(b) Auto accident - car overturned &V489

(c)

Code to car occupant injured in noncollision transport accident, unspecified (V489).

I (a) Fracture of ribs S223

(b)

(c)

MOD II &V892

Accident

Street

Vehicle Accident

Code to person injured in unspecified motor vehicle accident, traffic (V892). Code as motor vehicle accident since the accident occurred on the street.

I (a) Blunt force trauma T149 &V230

(b) Motorcycle accident in a field

(c)

MOD II

Accident

Driver of motorcycle vs parked cars

Code to motorcycle rider injured in collision with car, pick-up truck or van, driver, nontraffic (V230).

6. Occupant of special all-terrain or other motor vehicle designed primarily for off-road use, injured in transport accident (V86)

This category includes accidents involving an occupant of any off-road vehicle. The fourth character indicates whether the decedent was injured in a nontraffic or traffic accident. Unless stated to the contrary, these accidents are assumed to be nontraffic.

I (a) Multiple injuries T07

(b) Driver of snowmobile that collided with auto &V860

Code to driver of all-terrain or other off-road motor vehicle injured in traffic accident since the collision occurred with an automobile.

I (a) Injuries of head S099

(b) Fracture both legs T025

Code to driver of all-terrain or other off-road motor vehicle injured in nontraffic accident.

I (a) Head injuries S099

(b) Overturning snowmobile &V869

Code to unspecified occupant of all-terrain or other off-road motor vehicle injured in nontraffic accident.

I (a) Fracture skull S029

(b) ATV accident &V869

Code to unspecified occupant of all-terrain or other off-road motor vehicle injured in nontraffic accident (V869)

7. Scooter (motorized) vs Motor scooter

It is often hard to distinguish between when a scooter should be considered a pedestrian conveyance or a motorcycle.

In most cases, a scooter or motorized scooter refers to a motorized chair for people with immobility issues, code as a pedestrian conveyance. In instances where there is a scooter accident and POI is Home (with no other details provided) code to X599. However, if POI is street (with no other details provided) code to V099.

A motor scooter is a small motorcycle type vehicle, code to motorcycle.

I (a) Cardiopulmonary arrest I469

(b) Severe head injury S099

(c)

MOD II &W18

Accident

Home

Victim fell off of scooter

Code to fall, from, sitting height or position (W18). Code as pedestrian conveyance since scooter (motorized) is listed in Volume 1 under the definition (e) for pedestrian.

I (a) Multiple blunt force injuries T07 &V299

(b) Motor scooter incident

(c)

MOD II

Accident

Highway

Scooter incident

Code to motorcycle rider (any) injured in unspecified traffic accident (V299). Code as a motorcycle since motor scooter is listed in Volume 1 under definition (k) for motorcycle.

I (a) Injuries sustained in auto - motorized scooter collision T149 &V031

(b)

(c)

MOD II Chronic obstructive lung disease and generalized arteriosclerosis J449 I709

Accident

Street

Collision between automobile and motorized scooter, driver

Code to pedestrian injured in collision with car, pick-up truck or van (V031). Code as pedestrian conveyance since scooter (motorized) is listed in Volume 1 under the definition (e) for pedestrian.

I (a) Respiratory failure J969

(b) Pneumonia J189

MOD II Scooter accident &V299

Accident

Street

Moped crash

Code to motorcycle rider (any) injured in unspecified traffic accident (V299). Code as a motorcycle since moped is listed in Volume 1 under definition (k) for motorcycle.

PLACE I (a) Scooter accident T149 &X599

0 (b)

(c)

MOD II

Accident

home

Code to exposure to unspecified factor causing other and unspecified injury(X599). Code as pedestrian conveyance since scooter is listed in Volume 1 under definition (e) for pedestrian.

I (a) Scooter accident T149 &V099

(b)

(c)

MOD II

Accident

street

Code to pedestrian injured in unspecified transport accident(V099). Code as pedestrian conveyance since scooter(motorized) is listed in Volume 1 under the definition (e) for pedestrian.Scooter accidents occurring on the street are assigned to a transport category.

8. Traffic accident of specified type but victim’s mode of transport unknown (V87)
Nontraffic accident of specified type but victim’s mode of transport unknown (V88)

a. If more than one type of vehicle is mentioned, do not make any assumptions as to which vehicle was occupied by the victim unless the vehicles are the same. Instead, code to the appropriate categories V87-V88. Statements such as these do not indicate status of victim:

• Auto (passenger) vs. truck • Passenger car vs. truck

• Car vs. truck, driver • Car vs. truck, driver

• Driver, car vs. truck • Driver-car vs. truck

I (a) Intrathoracic injury S279

(b)

Do not make any assumption as to which vehicle the victim was occupying. Using the Index, code:

Accident

- transport (involving injury to) (see also ) V99

- - person NEC (unknown means of transportation) (in) V99

- - - collision (between)

- - - - car (with)

- - - - - two- or three-wheeled motor vehicle (traffic) V87.0

I (a) Multiple injuries T07

(b) Driver - collision of car and bus &V873

(c)

Do not make any assumption as to which vehicle the victim was driving. Using the Index, code:

Accident

- transport (involving injury to) (see also ) V99

- - person NEC (unknown means of transportation) (in) V99

- - - collision (between)

- - - - car (with)

- - - - - bus (traffic) V87.3

b. If reported types of vehicles are not indexed under Accident, transport, person, collision, code V877 for traffic and V887 for nontraffic.

I (a) Multiple injuries T07

(b) Bus and pick-up truck collision, driver &V877

(c)

Do not make any assumption as to which vehicle the victim was driving. Collision between bus and pick-up is not indexed under Accident, transport, person, collision. Code V877.

9. Water transport accidents (V90-V94)

The fourth character subdivision indicates the type of watercraft. Refer to Volume 1, Chapter XX, Water transport accidents for a list of the fourth character subdivisions.

I (a) Drowning T751 &V929

(b) Fell over-board

MOD II

Accident

Code drowning, due to fall overboard. Use fourth character “9,” unspecified watercraft.

10. Air and space transport accidents (V95-V97)

For air and space transport accidents, the victim is only classified as an occupant.

Military aircraft is coded to V958, Other aircraft accidents injuring occupant, since a military aircraft is not considered to be either a private aircraft or a commercial aircraft. Where death of military personnel is reported with no specification as to whether the airplane was a commercial or private craft, code V958.

11. Miscellaneous coding instructions (V01-V99)

a. When multiple deaths occur from the same transportation accident, all the certifications should be examined, and when appropriate, the information obtained from one may be applied to all. There may be other information available such as newspaper articles. A query should be sent to the certifier if necessary to obtain the information.

b. When classifying accidents which involve more than one kind of transport, use the following order of precedence:

aircraft and spacecraft (V95-V97)

watercraft (V90-V94)

other modes of transport (V01-V89, V98-V99)

I (a) Multiple fractures and internal injuries T029 T148

(b) Driver of car killed when a private plane &V973

Code to person on ground injured in air transport accident following above order of precedence. Refer to Index under Accident, transport, aircraft, person, on ground.

c. When no external cause information is reported and the place of occurrence of the injury was highway, street, road(way), or alley, assign the external cause code to person injured in unspecified motor vehicle accident occurring on the highway.

I (a) Head injuries and fracture S099 S029

MOD II &V892

Accident

Highway

Code to person injured in unspecified motor vehicle accident, traffic since the accident occurred on the highway.

d. Homicide, suicide or undetermined in manner of death

(1) When “undetermined” is reported in the manner of death box with transport accidents, code the external cause as accidental unless a statement on the certificate clearly establishes an investigation has not determined whether accidental, homicidal, or suicidal.

I (a) Multiple head injuries S097

(b) Car ran off cliff &V489

MOD II

Undetermined

Code I(a) as indexed. Code I(b) as unspecified car occupant injured in noncollision transport accident. Do not code to undetermined since there is no statement that clearly establishes an investigation resulted in an undetermined verdict.

Place I (a) Multiple head injuries S097

8 (b)Car ran off cliff &Y32

MOD II Police report indicates possible suicide or accident. Verdict

C pending.

Undetermined

Code I(a) as indexed. Code I(b) as indexed under Crash, transport vehicle, motor NEC, undetermined since there is a statement, which clearly establishes an investigation of “undetermined intent,” is pending.

(2) When “homicide” is reported in the manner of death box with transport accidents, code the external cause as accidental unless a statement on the certificate clearly establishes an intentional act of homicide occurred. Words like deliberately, intentionally, purposefully or assault can be interpreted as intentional and coded as homicide.

Place I (a) Multiple traumatic injuries T07

8 (b) Decedent run over by vehicle &Y03

several times in parking lot

MOD II

Homicide

Code I(a) as indexed. Code I(b) as indexed under Assault, crashing of motor vehicle. Homicide is coded since there was evidence the victim was repeatedly run over.

I (a) Multiple traumatic injuries T07

(b) Struck by car while walking on side of road &V031

MOD II

Homicide

Hit and run - driver left scene of accident

Code I(a) as indexed. Code pedestrian struck by car on I(b). Do not code as homicide since there is no statement of intentional homicide.

(3) When “suicide” is reported in the manner of death box with transport accidents, code the external cause qualified as suicide.

e. Garbage /dump truck accidents

When accidents involving garbage/dump trucks are reported and information indicates the mechanism of the body or truck bed caused the injuries, assign the E-code based on reported information. Usually, the statement of events will be falling on, struck by, or caught in and external codes W20, W22, or W23 will be used.

Place I (a) Crushed chest S280

4 (b) Dump truck body fell on chest &W20

MOD II

Accident

Street

Code external cause to Struck (by), object, falling, W20.

Place I (a) Fracture skull S029

4 (b) Struck by dump truck body &W22

MOD II

Accident

Street

Code external cause to Struck (by), object, W22.

Place I (a) Crushed chest S280

4 (b) Caught in compactor of garbage &W23

truck

MOD II

Accident

Street

Code external cause to Caught, between, objects, W23.

f. Use of asterisks to identify decedent's vehicle

When certifiers report a named vehicle preceded by a string of asterisks, interpret as the decedent's mode of transport.

I (a) Blunt force injuries T149 &V594

(b) Motor vehicle collision

MOD II

Accident

Driver of vehicle involved in two-vehicle collision ***vehicle = pickup truck/cargo van

Code I(a) as indexed. Code to occupant of pickup truck or van in collision with motor vehicle, driver.

K. Falls

1. Other fall on same level (W18)

Code W18 if other or additional information is reported about the fall such as:

Fell from standing height

Fell moving from wheelchair to bed

Fell striking head

Fell striking object

Fell to floor

Fell while transferring from chair to bed

Fell while walking

Lost balance and fell

Place I (a) Fracture right hip S720

0 II Lost balance and fell to floor &W18

MOD

Accident

Home

Code external cause to other fall on same level.

2. Unspecified fall (W19)

Code W19, unspecified fall, for terms such as:

Fall

Fell

Fell at a place

Place I (a) Fracture right hip S720

1 II Fell at nursing home &W19

MOD

Accident

Nursing Home

Code external cause to fall, unspecified.

3. Falls with other external events

When fall is reported more information must be obtained in order to assign the most appropriate code. This information will be reported in Part I and Part II of the medical certification, also the place of injury and the description of how injury occurred.

1. Is a vehicle or transport involved?

YES: Refer to coding instructions for categories V01 - V89. This includes reference to table of land transport accidents. This section also includes specific instructions for fall from transport vehicle.

NOTE: fall from animal: see V80-

2. Is a fire involved?

YES: Refer to coding instructions for categories X00 - X09. Review Threats to Breathing, Table 3, Fire.

3. Is machinery in operation involved?

YES: See code categories W28 - W31.

4. Is drowning or submersion in water involved?

YES: Refer to coding instructions for categories W65 - W74. Review Threats to Breathing, Table 1, Drowning and submersion, if applicable.

5. Is struck by a falling object involved?

YES: See code categories W20 - W49

6. Is a human stampede or pushed by a crowd involved?

YES: Code W52

If none of the above, see code categories W00 - W19 for specific codes.

L. Natural and environmental factors

1. Lightning

Code X33 only when the decedent is injured from direct contact with lightning.

Code injuries, such as stroke or shock, due to direct contact with lightning to T750.

Code burn(s) due to lightning to burn(s) (T200-T289, T300-T319).

Place I (a) Shock T750

9 (b) Struck by lightning T750 &X33

Place I (a) Burns T300

0 (b) House fire &X00

When a secondary fire results from lightning, code to the fire. Do not enter a code for lightning.

2. Exposure, cold exposure and hypothermia

When exposure, cold exposure or hypothermia is reported anywhere on the record with another stated or implied external cause, code the nature of injury code (T68-T699, T758) and the E-code for the exposure, cold exposure or hypothermia (X599, X31). Do not modify the nature of injury code for exposure NOS. Ampersand the external cause code for the other event.

Place I (a) Exposure T758 X599

9 (b) Intoxication with hip fx T519 &X45 S720

II X590

Place I (a) Hypothermia with drowning T68 X31 T751 &W74

9 (b)

(c)

Place I (a) Exposure T758 X83

4 (b)

Suicide

Jumped from bridge

Place I (a) Exposure to cold T699 X31

9 (b)

(c)

II MVA &V892

Place I (a) Exposure and hypothermia T758 X31 T68

9 (b) Unconsciousness R402

(c)

MOD II Blunt trauma to head S099 &W18 T758

Accident

Exposed to elements after falling and striking head

Place I (a) Hypothermia T68 X31

9 (b)

(c)

II Alcohol intoxication T519 &X45

3. Storms and Wildfires

Categories X30-X39 include deaths from direct effects of forces of nature.

General Guidelines

- Use these categories for deaths resulting from direct effects of the storm.

- Do not use these categories for deaths resulting from a second event, such as clean-up after a cataclysmic event.

- When hurricane, storm, etc is reported, consider references to power failure, loss of power, lack of air conditioning, etc as part of the storm and not a subsequent accident.

- Code wildfire as X01, Exposure to uncontrolled fire, not in building or structure

Place I (a) Drowned T751 &X37

9 (b) Car which decedent was driving was washed

Code as victim of cataclysmic storm (X37). The drowning was a direct result of the hurricane.

Place I (a) Suffocation T71 &X36

9 (b) Covered by landslide

(c)

Code as victim of avalanche, landslide and other earth movements (X36).

I (a) Ruptured diaphragm S278

(b) Driver of auto which struck &V475

Code as car occupant injured in collision with fixed or stationary object, driver (V475).

Place I (a) Acute respiratory failure J960

9 (b) Severe emphysema T797

Code as death from hurricane (X37). Consider statement of loss of air conditioner power as part of the storm. The external cause code for storm is assigned where first reported on the record.

I (a) Fracture vertebra T08

(b) Contusion spinal cord T093

II Working to restore power from hurricane

Accident

Light pole fell on him

Code as struck by falling object (W20). This is clearly a subsequent accident and not a direct impact of the storm.

Place I (a) Smoke inhalation T598 &X01

9 (b)

MOD (c)

A II Wildfire

Accident

Wildfire

Code as wildfire (X01). Follow the Index as Exposure, fire, uncontrolled, not in building or structure.

Place I (a) Thermal injuries and smoke inhalation T300 &X01 T598

0 (b)

MOD (c)

A II Multiple sclerosis G35

Accident

Home

Unable to leave home - overcome by wildfire

Code as wildfire (X01) since this house fire resulted from the wildfire. Follow the Index as Exposure, fire, uncontrolled, not in building or structure.

M. Firearms and firearm injuries

1. Coding specific types of firearms

The type of firearm involved in a death is identified at the three character level. Use the following guide to identify the type of firearm:

Intentional Undetermined

Type Firearm Accidental Self-harm Assault Intent

Handgun W32 X72 X93 Y22

25 Caliber

32 Caliber

38 Caliber

45 Caliber

357 Magnum

380 Caliber

Pistol

Revolver Saturday night

special

Rifle, shotgun, larger W33 X73 X94 Y23

firearm

25.06 (25 ought 6)

30.6 (30 ought 6)

30/30

308

AK47

M1 (carbine)

M14

M16

Machine gun

Rifle (army) (hunting)

(military)

Shotgun (8, 10, 12, 16, 20,

410 gauge,

buckshot)

Other and unspecified W34 X74 X95 Y24

firearms

9 mm

22 Caliber gun

30 Caliber gun

Airgun

BB gun

Pellet gun

Pellet pistol

Pellet rifle

Very pistol (Flare)

2. External cause code

When reported as Code

“playing with gun” NOS or external cause as accidental (W32-

“cleaning gun” NOS W34)

“playing Russian external cause as handgun accident

roulette” (whether or not stated (W32)

suicide)

Place I (a) Gunshot wound of femur S711 &W34

9 (b) Cleaning gun T141

Code as accidental since reported due to cleaning gun.

Place I (a) Gunshot wound chest S219 &W32

9 (b)Self-inflicted while playing Russian roulette

MOD II

Suicide

Code as handgun accident since Russian roulette is reported.

3. Nature of injury code

When Is reported due to Code

Injury NOS any caliber the nature of injury to wound

bullet

gun went off

pulled trigger

specified firearm

Place I (a) Injury T141

9 (b) Rifle T141 &W33

When reported as Code

Gunshot or bullet entering and/or exiting a site the nature of injury to wound of site(s)

Place I (a) Bullet entering chest & S219 &W34 S212

9 (b) exiting back

When reported as Code

Bullet (to site) the nature of injury to wound (of site(s))

Gunshot (to site)

Shoot, shooting, shot (to site)

Shotgun blast (to site)

Place I (a) Shot in head S019 &W34

4. Other firearm examples

Place I (a) Gunshot wound chest S219 &Y24

9 (b) Self-inflicted

Code as undetermined gunshot since self-inflicted is reported and is unspecified as accidental or intentional.

Place I (a) Gunshot injury chest S219 &W34 S273

9 (b) and lung

Code the nature of injury to wound of sites and external code to accidental gunshot wound

N. Child abuse, battering and other maltreatment (Y070-Y079)

Code to Child battering and other maltreatment (Y070-Y079) if the age of the decedent is under 18 years and the cause of death meets one of the following criteria:

1. The certifier specifies abuse, battering, beating, or other maltreatment, even if homicide is not specified.

Male, 3 years

I (a) Traumatic head injuries S099

(b)

(c)

MOD II &Y079

Homicide

Home

Deceased had been beaten

2. The certifier specifies homicide and injury or injuries with indication of more than one episode of injury, i.e., current injury coupled with old or healed injury consistent with a history of child abuse.

Male, 1-1/2 years

I (a) Anoxic encephalopathy G931

(b) Subdural hematoma S065

MOD II &Y079

Homicide

3. The certifier specifies homicide and multiple injuries consistent with an assumption of battering or beating, if assault by a peer, intruder, or by someone unknown to the child cannot be reasonably inferred from the reported information.

Female, 1 year

I (a) Massive internal bleeding T148

(b) Multiple internal injuries T065

(c)

MOD II Injury occurred by child being struck T149 &Y079

Homicide

Exception:

Deaths at ages under 18 years for which the cause of death certification specifies homicide and an injury occurring as an isolated episode, with no indication of previous mistreatment, should not be classified to Y070-Y079. This excludes from Y070-Y079 deaths due to injuries specified to be the result of events such as shooting, stabbing, hanging, fighting, or involvement in robbery or other crime, because it cannot be assumed such injuries were inflicted simply in the course of punishment or cruel treatment.

Female, 1 year

Place I (a) Hypovolemic shock T794

0 (b) Laceration of heart S268

MOD II Stabbed with kitchen knife by mother T141

Homicide

Home

O. Guides for differentiating between effects of external causes classifiable to Chapters I - XVIII and Chapter XIX

Categories in Chapters I-XVIII and XIX are mutually exclusive. Where provision has been made for coding effects of an external cause to Chapters I-XVIII, do not use a nature of injury code.

The effects of external causes classifiable to Chapters I-XVIII are primarily those associated with drugs, medicaments and biological substances, surgical procedures, and other medical procedures. Refer to Section V, Part R, Complications of medical and surgical care (Y40-Y84).

A limited number of conditions that can result from other external causes, e.g., certain localized effects of fumes, vapors and nonmedicinal chemical substances and respiratory conditions from aspiration of foreign substances are also classified to Chapters I-XVIII. It is intended that Chapters I-XVIII be used to identify the localized effects and the substance be identified by the external cause code in Chapter XX.

To determine if the conditions reported due to external causes, other than drugs, medicaments, and biological substances, surgical procedures, and other medical procedures, are classified to localized effects in Chapters I-XVIII or to the nature of injury in Chapter XIX - look up the stated condition in the Index and scan the listing under this condition for qualifying terms that relate to the reported external cause. For example, to determine whether pneumonia due to aspiration of vomitus should be coded to Chapter X or to Chapter XIX, look up “Pneumonia, aspiration, due to, food (regurgitated), milk, vomit.” This determination cannot be made by looking up “Aspiration.” Where there is provision in the Index for coding a condition due to an external cause to Chapter I-XVIII, take the external cause into account if it modifies the coding.

I (a) Pneumonia &J690

(b) Aspiration of vomitus W78

Code Pneumonia, aspiration, due to vomit. Code “aspiration of vomitus” as an external cause code only.

I (a) Pneumonia &J690

(b) Aspiration W80

Code Pneumonia, aspiration. Code I(b) “aspiration” as an external cause code only.

I (a) Pneumonia &J690

(b) Asphyxia W80

Code Pneumonia, aspiration. Code I(b) external cause code only.

I (a) Pneumonia &J680

(b) Smoke inhalation X00

II House fire

Code Pneumonia, in (due to), fumes and vapors (J680). Code I(b) external cause code only.

I (a) Acute pulmonary edema &J681

(b) Inhaled gasoline fumes X46

Code Edema, pulmonary, acute, due to, chemicals fumes or vapors (J681). Code I(b) external cause code only.

Place I (a) Pneumonia J189

9 (b) Cardiac arrest I469

Code each entity as indexed. Do not code the pneumonia on I(a) due to aspiration of vomitus since it is reported due to another condition.

Place I (a) MRSA Pneumonia J152

9 (b) Aspiration T179 &W80

Code each entity as indexed. Do not code the pneumonia on I(a) as due to aspiration since it is not together in the Index.

Place I (a) Viral Pneumonia J129

9 (b) Aspiration T179 &W80

Code each entity as indexed. Do not code the pneumonia on I(a) as due to aspiration since it is not together in the Index.

P. Threats to breathing

Certain effects of external causes can be classified to more than one nature of injury code depending on the type of external cause. Some of these effects are “anoxia,” “asphyxia,” “aspiration,” “choking,” “compression of neck,” “obstruction of a site,” “strangulation,” “stricture of neck,” and “suffocation.”

The most frequently reported external causes which result in these effects are “aspiration, ingestion, and inhalation of objects and substances,” “drowning,” “fires,” “fumes, gases and vapors,” “hanging,” “mechanical strangulation and suffocation,” and “submersion.”

The following pages contain tables that are used as guides in coding these types of external causes and effects.

In general, if the specific external cause is not in Tables 1-5, it will most likely be in Table 6, which contains the most frequently reported external causes which result in asphyxia, suffocation, etc. If not in any of the tables, code the effect as indexed.

Table Title

Table 1 Drowning and submersion

Table 2 *Hanging and mechanical

strangulation (by external means)

Table 3 Fires (includes burns, gases, fumes in

association with burns and fires)

Table 4 Ingestion, inhalation of gases, fumes,

vapors (without fires, burns)

Table 5 Compression chest, crushed chest by

external means

Table 6 Aspiration NOS, ingestion NOS,

inhalation NOS or aspiration, ingestion,

inhalation of substances or objects

(W78, W79, W80)

*NOTE: Interpret mechanical strangulation as strangulation caused by external means to the exterior of the body.

Table 1. Drowning and submersion

Instruction

When

Is reported due to

Code

anoxia

asphyxia

strangulation

suffocation

drowning

submersion

upper line T751 and the appropriate external cause code.

lower line T751

only.

Examples - Corresponding Table and Instruction 1.1

Place I (a) Asphyxia T751 &W69

8 (b) Drowning T751

MOD (c)

A II T751

Accident

Drowned while swimming in river

I (a) Asphyxia T751 &V909

(b) Strangulation T751

MOD (c) Drowning T751

A II

Accident

Lake

Boat Overturned

Place I (a) Anoxia T751 &W70

8 (b) Drowning T751

MOD (c)

A II

Accident

Fell into Lake

Instruction

When

Is reported on the same line with

Code

anoxia

asphyxia

strangulation

suffocation

drowning

submersion

T751 and the appropriate external cause code.

Example - Corresponding Table and Instruction 1.2

Place I (a) Drowning - asphyxia T751 &W69

8 (b)

MOD (c)

A II

Accident

Pond

Table 2. Hanging and mechanical strangulation (by external means)

Instruction

When

Is reported due to

Code

asphyxia

strangulation

suffocation

hanging

mechanical strangulation

(by external means)

compression of neck

upper line T71 and the appropriate external cause code.

lower line T71 only.

Examples - Corresponding Table and Instruction 2.1

Place I (a) Asphyxia T71 &X70

0 (b) Hanging T71

MOD (c)

S II

Suicide

Home

Place I (a) Aspiration of vomitus T179 W78

0 (b) Strangulation T71 &X70

MOD (c) Hanging T71

S II T71

Suicide

Home

Hanged Self

I (a) Asphyxia T71 &V499

(b) Compression of neck T71

Instruction

When

Is reported on the record with

Code

asphyxia

strangulation

suffocation

hanging

mechanical strangulation

(by external means)

compression of neck

the asphyxia, strangulation, suffocation, T71 followed by the appropriate external cause code.

T71 only where the hanging, mechanical strangulation, compression of neck is reported.

Example - Corresponding Table and Instruction 2.2

Place I (a) Suffocation by hanging T71 &X70

9 (b)

MOD (c)

S II T71

Suicide

Hanging by neck

Male 1 month old

Place I (a) Suffocation T71 &W75

9 (b)

MOD (c)

A II

Accident

Co-sleeping with adults

Place I (a) Asphyxia T71 &W84

7 (b) Entrapment in grain bin

MOD (c)

A II

Accident

Farm

Fell into grain bin and became trapped under corn

Instruction

When

Is reported due to

Which is reported due to

Code

asphyxia

strangulation

suffocation

asphyxia

strangulation

suffocation

the external means of the mechanical strangulation

(such as: ligature, rope around neck, sheet )

uppermost line to T71 and the appropriate external cause code.

the next lower line to T71.

lower line blank.

Example - Corresponding Table and Instruction 2.3

Place I (a) Asphyxia T71 &W75

9 (b) Suffocation T71

Instruction

When

Is reported due to

Code

compression

of neck

stricture of

neck

hanging

mechanical strangulation

(by external means)

suffocation

upper line T71 only.

lower line T71 and the appropriate external cause code.

Example - Corresponding Table and Instruction 2.4

Place I (a) Compression of neck T71

9 (b) Hanging T71 &X91

MOD (c)

H II T71

Homicide

Hanging

Instruction

When

Is reported on the record with

Code

compression
of neck
stricture of
neck

hanging
mechanical strangulation
(by external means)
suffocation

compression of neck, stricture of neck to T71 only.

T71 followed by the appropriate external cause code for the hanging, mechanical strangulation, suffocation.

Example - Corresponding Table and Instruction 2.5

Place I (a) Compression of neck T71

9 (b)

MOD (c)

H II Strangulation by cord around neck T71 &X91

Homicide

Table 3. Fires (includes burns, gases, fumes in association with burns and fires)

Instruction	When	Is reported due to		Code
1	asphyxia suffocation	ingestion, inhalation	of gas, fumes, or vapors (carbon monoxide, products of combustion, smoke)	the asphyxia, suffocation to the nature of injury code for the gas, fumes, vapor and the appropriate external cause code for the fire where required. lower line to the appropriate nature of injury code for the gas, fumes, vapor.
		with mention of a fire (specified)

Examples - Corresponding Table and Instruction 3.1

Place I (a) Suffocation T599 &X00

0 (b) Inhalation of products of combustion T599

MOD (c)

A II T599

Accident

Inhaled fumes in house fire

Place I (a) Suffocation T598 &X09

9 (b) Smoke inhalation T598

MOD (c) Fire

A II

Accident

Instruction	When	Is reported on the record with		Code
2	asphyxia suffocation	ingestion, inhalation	of gas, fumes, or vapors (carbon monoxide, products of combustion, smoke)	the asphyxia, suffocation to the nature of injury code for the gas, fumes, vapor and the appropriate external cause code for the fire where required. the appropriate nature of injury code for the gas, fumes, vapor where reported.
		with mention of a fire (specified)

Example - Corresponding Table and Instruction 3.2

Place I (a) Asphyxia - carbon monoxide T58 &X00

0 (b)

MOD (c)

A II

Accident

Home

House Fire

Instruction When Is reported due to Code

3 asphyxia burns NOS upper line T300 and the

suffocation (any degree) appropriate external cause code

(any percentage)

(any site) lower line as indexed.

Examples - Corresponding Table and Instruction 3.3

Place I (a) Asphyxia T300 &X04

0 (b) Burns of chest and face T210 T200

MOD (c)

A II

Accident

Home

Ignition of kerosene

Place I (a) Suffocation T300 &X00

9 (b) 3° burns T303

MOD (c)

A II

Accident

Burning Bldg.

Instruction

When

Is reported due to

Code

asphyxia

suffocation

fire NOS

specified fire

upper line T300 and the appropriate

external cause code.

lower line blank.

Instruction

When

Is reported on the record with

Code

asphyxia suffocation

fire NOS

specified fire

the asphyxia, suffocation T300, followed by the appropriate external cause code for the fire.

Example - Corresponding Table and Instruction 3.5

Place I (a) Asphyxia, fire in house T300 &X00

0 (b)

(c)

Table 4. Ingestion, inhalation of gases, fumes, vapors (without fires, burns)

Instruction	When	Is reported due to		Code
1	asphyxia suffocation	ingestion, inhalation	of gas, fumes, or vapors	upper line to the appropriate nature of injury code for the gas, fumes, or vapor and the appropriate external cause code. lower line to the appropriate nature of injury code for the gas, fumes, or vapor.

Example - Corresponding Table and Instruction 4.1

Place I (a) Asphyxia T58 &X67

0 (b) Inhalation of carbon monoxide T58

MOD (c)

S II T58

Suicide

Home

Inhaled car exhaust fumes in garage

Place I (a) Asphyxiation T598 &X67

8 (b) Plastic bag over head with helium infusion T598

MOD (c)

S II T598

Suicide

Lot

Placed plastic bag over head. Tube from helium tank inserted under bag.

Instruction	When	Is reported on the same line with		Code
2	asphyxia suffocation	ingestion, inhalation	of gas, fumes, or vapors	the appropriate nature of injury code for the gas, fumes, or vapor and the appropriate external cause code.

Example - Corresponding Table and Instruction 4.2

Place I (a) Suffocation by inhalation of propane gas T598 &X47

0 (b)

MOD (c)

A II T598

Accident

Home

Inhaled propane gas

Table 5. Compression chest, crushed chest by external means

Instruction

When

Is reported due to

Code

asphyxia

suffocation

crushed chest

upper line S280 plus the appropriate external cause code.

lower line S280.

Example - Corresponding Table and Instruction 5.1

I (a) Asphyxia S280 &V892

(b) Crushed chest S280

MOD (c) MVA

A II

Accident

Street

MVA

Instruction

When

Is reported due to

Code

asphyxia

suffocation

compression chest

upper line S299 plus the appropriate external cause code.

lower line S299.

Example - Corresponding Table and Instruction 5.2

Place I (a) Suffocation S299 &W30

7 (b) Compression chest S299

MOD (c) Tractor accident

A II

Accident

Farm

Tractor overturned on victim

Table 6. Aspiration NOS, ingestion NOS, inhalation NOS, or aspiration, ingestion, inhalation of substances or objects (W78, W79, W80)

EXCLUDES: Ingestion, inhalation of drugs and poisonous substances

Instruction	When	Is reported due to		Code
1	asphyxia aspiration choking obstruction of a site occlusion of a site strangulation suffocation	aspiration NOS ingestion NOS inhalation NOS or		upper line to T17 plus appropriate fourth character and the appropriate external cause code (W78, W79, W80). lower line to T17 with appropriate fourth character.
		aspiration ingestion inhalation	of substances or objects

Examples - Corresponding Table and Instruction 6.1

Place I (a) Strangulation T179 &W79

9 (b) Aspiration of food T179

(c)

Place I (a) Asphyxia T179 &W78

9 (b) Aspiration T179

Place I (a) Choked T179 W80

9 (b) Aspiration of blood T179

II Car vs. Pedestrian &V031

Instruction

When

Is reported due to

Code

asphyxia

aspiration

choking

obstruction of a site

occlusion of a site

strangulation

suffocation

foreign body in a site (such as: blood, food, gum, medicine, mucus, vomitus)

upper line to T17 plus appropriate fourth character and the appropriate external cause code (W78, W79, W80).

lower line to T17 with appropriate fourth character.

Example - Corresponding Table and Instruction 6.2

Place I (a) Obstruction of pharynx T172 &W79

9 (b) Bolus of meat in throat T172

(c)

Instruction

When

Is reported due to

Code

asphyxia

aspiration

choking

obstruction of a site

occlusion of a site

strangulation

suffocation

foreign body NOS

(such as: blood, food, gum, medicine, mucus, vomitus)

upper line to T17 plus appropriate fourth character and the appropriate external cause code (W78, W79, W80).

lower line blank.

Examples - Corresponding Table and Instruction 6.3

Place I (a) Obstruction of trachea T174 &W79

9 (b) Bolus of meat

(c)

Place I (a) Asphyxia T179 &W78

9 (b) Aspiration T179

Instruction	When	Is reported on the same line with		Code
4	asphyxia aspiration choking obstruction of a site occlusion of a site strangulation suffocation	aspiration NOS ingestion NOS inhalation NOS or		on the same line, T17 with appropriate fourth character and the appropriate external cause code (W78, W79, W80).
		aspiration ingestion inhalation	of substances or objects

Example - Corresponding Table and Instruction 6.4

Place I (a) Asphyxia by aspiration of vomitus T179 &W78

9 (b)

(c)

Instruction

When

Is reported on the same line with

Code

asphyxia

aspiration

choking

obstruction of a site

occlusion of a site

strangulation

suffocation

foreign body in a site (such as: blood, food, gum, medicine, mucus, vomitus)

on the same line, T17 with appropriate fourth character and the appropriate external cause code (W78, W79, W80).

Example - Corresponding Table and Instruction 6.5

Place I (a) Choked by peanut obstructing trachea T174 &W79

9 (b)

(c)

Instruction

When

Is reported on the same line with

Code

asphyxia

aspiration

choking

obstruction of a site

occlusion of a site

strangulation

suffocation

foreign body NOS (such as: blood, food, gum, medicine, mucus, vomitus)

on the same line, T17 with appropriate fourth character and the appropriate external cause code (W78, W79, W80).

Examples - Corresponding Table and Instruction 6.6

Place I (a) Choked on chicken bone T179 &W79

9 (b)

(c)

Place I (a) Obstruction airway by bolus of food T179 &W79

9 (b)

(c)

Instruction

When

Is reported due to

Code

aspiration NOS

aspiration of substances

strangulation NOS

strangulation by substances

a disease

upper line T17 plus appropriate fourth character and the appropriate W78, W79, W80 if not previously coded.

lower line as indexed.

Example - Corresponding Table and Instruction 6.7

Place I (a) Aspiration T179 &W80

9 (b) C.V.A I64

(c)

Place I (a) Cerebro vascular accident I64

9 (b) Aspiration T179 &W80

MOD (c) Acute respiratory failure with hypoxemia J960 R090

C II

Could not be determined

Instruction When Is reported due to Code

8 aspiration NOS vomiting upper line T179, W78.

lower line R11.

Example - Corresponding Table and Instruction 6.8

Place I (a) Aspiration T179 &W78

9 (b) Vomiting R11

(c)

Instruction	When		Is reported due to	Code
9	aspiration NOS ingestion NOS inhalation NOS or		injuries (other than those classified to T17-) and/or an external cause (other than W78, W79, W80)	upper line T17 plus appropriate fourth character. Also, code the appropriate W78, W79, W80 if not previously coded. lower line as indexed.
	aspiration ingestion inhalation	of substances or objects

Examples - Corresponding Table and Instruction 6.9

Place I (a) Aspiration of vomitus T179 W78

0 (b) Strangulation T71 &X70

MOD (c) Hanging T71

S II T71

Suicide

Home

Hanged Self

Place I (a) Choked T179 W80

9 (b) Aspiration of blood T179

II Car vs. Pedestrian &V031

Place I (a) Aspiration T179 W80

9 (b) Drowning T751 &W74

MOD (c)

A II

Accident

Place I (a) Pneumonia J189

9 (b) Cardiorespiratory arrest I469

MOD (c) Aspiration T179 &Y33

C II

Could not be determined

Since none of the previous instructions apply, assign the e-code for aspiration to the undetermined category.

Q. Poisoning

When poisoning (any) is reported, code nature of injury code and external cause code for the substance.

When poisoning by fumes, gas, liquids, or solids is reported, refer to Index under “Poisoning (acute)” to determine the nature of injury code for the substance.

To determine the external cause code when a poisonous substance is ingested, inhaled, injected, or taken, refer to the description of such circumstances (acts) for example, Ingestion, Inhalation, or Took.

When a condition is reported due to poisoning and the Index provides a code for the condition qualified as “toxic,” use this code. If the Index does not provide a code for the condition qualified as “toxic,” code the condition as indexed.

1. Poisoning by substances other than drugs

Assume poisoning (self- inflicted) by a substance to be accidental unless otherwise indicated.

Place I (a) Aplastic anemia D612

9 (b) Benzene poisoning T521 &X46

Code I(a) Anemia, aplastic, toxic. Code I(b) to nature of injury and external cause code for benzene poisoning from Table of Drugs and Chemicals.

Place I (a) Toxic poisoning T659 &X46

9 (b) Drank turpentine T528

Code I(a), nature of injury code for poison NOS and the most specific external cause code (turpentine) taking into account the entire certificate. Code nature of injury for turpentine on I(b).

a. Carbon monoxide poisoning

Code carbon monoxide poisoning from motor vehicle exhaust gas to noncollision motor vehicle accident (traffic) according to type of motor vehicle involved unless there is indication the motor vehicle was not in transit. Consider statements of “sleeping in car,” “sitting in parked car,” “in parked car” or place stated as “garage” to indicate the motor vehicle was “not in transit.” Assume “not in transit” in self-harm (intentional) and self-inflicted cases.

I (a) Carbon monoxide poisoning T58 &V892

(b)

(c)

II Motor vehicle exhaust gas T58

Code I(a) nature of injury for carbon monoxide and most specific external cause. Code external cause to person injured in unspecified motor vehicle accident, traffic. Refer to Table of land transport accidents under Victim and mode of transport. Select occupant of motor vehicle (traffic), noncollision transport accident. Code nature of injury for exhaust gas in Part II.

Place I (a) Poisoned by carbon monoxide T58 &X47

9 II Sitting in parked car

Code I(a) nature of injury and external cause for carbon monoxide from Table of drugs and chemicals. The external cause includes poisoning by gas, motor exhaust, not in transit.

Place I (a) Carbon monoxide inhalation T58 &X67

5 II Found in garage. Suicide.

Code I(a) nature of injury and external cause for carbon monoxide from Table of drugs and chemicals. The external cause includes intentional self-harm poisoning by gas, motor exhaust, not in transit.

b. Inhalation and sniffing sprays and aerosol substances

When inhalation of sprays, aerosol substances, etc. is reported, code to the appropriate accidental poisoning category for the external cause.

Exceptions:

"Glue sniffing" and "cocaine sniffing" and "huffing" are indexed to mental and behavioral disorders due to psychoactive substance use (F181, F142, F181).

Place I (a) Toxicity T659 &X46

0 (b) Inhalation of aerosol substance T659

(c)

MOD II Breathed “PAM” (freon) in plastic bag T535

Accident

Home

Code I(a) nature of injury code for toxicity as indexed. Code external cause to accidental inhalation of freon gas or spray (X46), the specific substance indicated by the certifier. Code nature of injury for aerosol on I(b) and freon in Part II.

c. Intoxication by certain substances or toxic poisoning due to disease

When ammonia intoxication (NH), carbon dioxide intoxication (C0), or toxic poisoning is reported due to a disease, do not code to poisoning. When due to a disease, code ammonia intoxication to R798, carbon dioxide intoxication to R068, and toxic poisoning to R688.

I (a) Ammonia intoxication R798

(b) Cirrhosis of liver K746

Code I(a) as indexed, Intoxication, ammonia, due to disease (R798).

I (a) Carbon dioxide intoxication R068

(b) Chronic pulmonary emphysema J439

Code I(a) as indexed, Intoxication, carbon dioxide, due to disease (R068).

I (a) Toxic poisoning R688

(b) Gastroenteritis A099

Code I(a) as indexed, Poisoning, toxic, from a disease (R688).

d. Condition qualified as “toxic” with poisoning reported

(1) When a condition is qualified as “toxic” and there is indication of poisoning on the certificate, code the external cause code for the poisoning where the “toxic” is reported, followed by the condition code. If the Classification provides a code for the condition qualified as “toxic,” use this code. If no provision is made for qualifying the condition as toxic, code to the unspecified code for the condition.

Place I (a) Toxic nephritis &X48 N144

9 II Organophosphate poisoning, T600

accidental

Code most specific external cause code on I(a) where toxic is reported followed by condition code for toxic nephritis as indexed. Code nature of injury for organophosphate in Part II.

Place I (a) Toxic GI hemorrhage &X49 K922

9 (b) Carbolic acid T540

Code most specific external cause code on I(a) where toxic is reported followed by condition code for GI hemorrhage as indexed. The Classification does not provide a code for GI hemorrhage qualified as toxic. Code nature of injury for carbolic acid on I(b).

Place I (a) Toxic diarrhea &X48 K521

9 II Rat poison T604

Code most specific external cause code on I(a) where toxic is reported followed by condition code for toxic diarrhea as indexed. Code nature of injury for rat poison in Part II.

(2) When a condition is qualified as “toxic” and there is no indication of poisoning on the certificate, code the condition as indexed to the unspecified code.

I (a) Toxic anemia D612

Code toxic anemia as indexed since there is no indication of poisoning on the certificate.

2. Poisoning by drugs

a. When the following statements are reported, see Table of Drugs and Chemicals and code as accidental poisoning unless otherwise indicated.

Interpret all these statements to mean poisoning by drug and code as poisoning whether or not the drug was given in treatment:

Drug taken inadvertently

Lethal (amount) (dose) (quantity) of a drug

Overdose of drug

Poisoning by a drug

Toxic effects of a drug

Toxic reaction to a drug

Toxicity (of a site) by a drug

Wrong dose taken accidentally

Wrong drug given in error

Place I (a) Cardiac arrest I469

9 (b) Digitalis toxicity T460 &X44

Code digitalis toxicity to digitalis poisoning. Code nature of injury and external cause code for digitalis poisoning on I(b). Do not ampersand a disease condition when poisoning from a drug occurs while the drug is being administered for medical reasons.

Place I (a) Shock R578

9 (b) Insulin overdose T383 &X44

Code I(a) shock, toxic since reported due to poisoning. Code insulin overdose to insulin poisoning. Code nature of injury and external cause code for insulin poisoning on I(b). Do not ampersand a disease condition when poisoning from a drug occurs while the drug is being administered for medical reasons.

b. Interpret the terms

(1) “intoxication by drug” to mean poisoning by drug unless indicated or stated to be due to drug therapy or as a result of treatment for a condition (refer to Section V, Part R, 1, (6), “Intoxication by drug” due to drug therapy).

Place I (a) Respiratory failure J969

9 (b)Drug intoxication T509 &X44

II Ingested undetermined T509

amount of drugs

Code “drug intoxication” to poisoning when there is no indication the drug was given for therapy. Code I(b) nature of injury and external cause code for drug poisoning. Code nature of injury code for drug NOS in Part II.

(2) intentional with drug poisoning as Suicide. If the manner of death is reported as something other than Suicide, code as undetermined. If, however, the manner of death is marked Natural, Blank, or Pending Investigation code as Suicide.

Place I (a) Sudden cardiac arrest I469

9 (b) Intentional drug overdose T509 &X64

II Morbid obesity, obstructive sleep apnea, hypertension E668 G473 I10

Natural

Code I(a) as indexed. Code the nature of injury and external cause code for drug nos as suicide on line I(b) since intentional is reported with drug poisoning and the manner of death box is marked Natural. Code Part II conditions as indexed.

c. When poisoning by drug NOS is reported in Part I and a specified drug is reported in Part II, code the external cause code to the specified drug.

Place I (a) Took overdose of drug T509 &X41

9 II Overdose of barbiturates T423

Code “took overdose of drug” as accidental unless otherwise specified. Code I(a) nature of injury for drug NOS and external cause code to the specified drug reported in Part II. Code nature of injury for barbiturates in Part II.

d. When a condition is qualified as “toxic” or “drug induced” and there is indication of drug poisoning on the certificate, code the external cause code for the drug poisoning where the “toxic” or “drug induced” is reported, followed by the condition code. If the Classification provides a code for the condition qualified as “toxic”, “due to drug” or “drug induced,” use this code. If no provision is made for qualifying the condition as “toxic”, “due to drug” or “drug induced,” whichever applies, code to the unspecified code for the condition. Code the nature of injury code for poisoning by the specified drug. NOTE: Depending on how the record is reported, the placement of the N & E may vary. See examples below.

Place I (a) Toxic hemolytic anemia &X41 D594

9 (b) Levodopa toxicity T428

Code most specific external cause on I(a) where toxic is reported followed by condition code for toxic hemolytic anemia as indexed. Code nature of injury for levodopa on I(b).

Place I (a) Drug induced hemolytic anemia &X41 D592

9 (b) Levodopa toxicity T428

Code most specific external cause on I(a) where drug induced is reported followed by condition code for Anemia, hemolytic due to, drugs as indexed. Code nature of injury for levodopa on I(b).

Place I (a) Drug induced hypotension &X44 I952

9 II Drug induced hypotension T509 I952

MOD

Accident

Code external cause on I(a) where drug induced is reported followed by condition code for drug induced hypotension as indexed. Code nature of injury for drug NOS in Part II.

Place I (a) Drug induced hypotension T509 &X44 I952

9 II

MOD

Accident

Code nature of injury and external cause on I(a) where drug induced is reported followed by condition code for drug induced hypotension as indexed. Since there are no other drugs reported, the nature of injury code is placed on line (a).

When a condition is qualified as “toxic” and there is no indication of drug poisoning on the certificate, code the condition as indexed.

When a condition is qualified as “drug induced” and there is no mention of drug poisoning on the certificate, code as a complication of drug therapy.

e. Poisoning by combination of drugs (X40-X44)

(1) When poisoning by a combination of drugs is stated or indicated to be accidental, intentional self-harm (suicide), or undetermined code as follows:

(a) When poisoning by a combination of drugs classified to the same external cause code is reported, use that external cause code.

Place I (a) Doxepin and barbiturate overdose T430 &X41 T423

Code external cause code to X41 since both doxepin and barbiturates are indexed to this code. Code nature of injury for each drug reported.

Place I (a) Doxepin and prozac overdose T430 &X61 T432

MOD

Suicide

Code external cause code to X61 since both doxepin and prozac are indexed to this code. Code nature of injury for each drug reported.

(b) When poisoning from a single drug is reported in Part I with a combination of drugs in Part II, code the external cause code for the drug reported in Part I. Code the nature of injury for each drug reported.

Place I (a) Acute barbiturate intoxication T423 &X41

9 II Took unknown amount of T423 T390

MOD barbiturates and aspirin

Accident

Code external cause code to X41, accidental poisoning by barbiturates, the single drug reported in Part I. Code nature of injury for barbiturates on I(a) and for barbiturates and aspirin in Part II.

(c) When poisoning by a combination of drugs classified to different external cause codes is reported and (b) does not apply, use the following external cause codes when the manner of death is reported as:

Accident	Code X44, Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances.
Intentional self-harm (Suicide)	Code X64, Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances.
Undetermined	Code Y14, Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent.

NOTE: This does not apply to chemicals such as carbon monoxide and acetone.

Place I (a) Drug intoxication T509 &X44

9 (b) Digitalis, cocaine T460 T405

The external cause code for accidental poisoning by digitalis is X44 and for cocaine is X42. Since the drugs are assigned to different external cause codes, code X44, Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances. Code nature of injury for each drug reported.

Place I (a) Drug toxicity T509 &X64

9 (b) Overdose of salicylates T390 T423

MOD II Overdose of drugs T509

Suicide

The external cause code for intentional self-harm (suicide) by salicylates is X60 and for seconal, X61. Since the drugs are assigned to different external cause codes, code X64, Intentional self poisoning by and exposure to other and unspecified drugs, medicaments and biological substances. Code nature of injury for each drug reported.

Place I (a) Darvon and promazine T404 &Y14 T433

9 (b) intoxication

MOD II Drug intoxication T509

Undetermined

The external cause code for poisoning of undetermined intent by darvon is Y12 and for promazine, Y11. Since the drugs are assigned to different external cause codes, code Y14, Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent. Code nature of injury for each drug reported.

3. Percentage of drug(s) in blood

When a percentage (%) of any drug(s) in the blood, code the nature of injury code for the drug if there is mention of drug poisoning elsewhere on the record.

When a complication is reported due to a percentage (%) of any drug(s), code as a complication of drug therapy unless otherwise indicated.

When a percentage (%) of any drug(s) in the blood without mention of drug poisoning or a complication, do not enter a code for the drug.

Place I (a) Gunshot wound brain S069 &X74

9 II .05 mg. barbiturates in blood

MOD

Suicide

Since there is no mention of poisoning or a complication of the barbiturates, do not enter a code for the percentage of drug in the blood.

4. Poisoning by alcohol and drugs

When alcoholism or alcohol poisoning (any F10-, R780, R826, R893, T510-T519) is reported in Part I with drug poisoning in Part I, code the alcohol to the appropriate code (F10-, R780, R826, R893, T510-T519), the nature of injury code for the drug and code the appropriate external cause code for the drug preceded by an ampersand. If alcohol poisoning is reported, code the external cause code for alcohol also, but do not precede this code with an ampersand. Interpret the following statements to mean poisoning by alcohol and drugs and code the appropriate E-code for alcohol poisoning:

Alcohol and drug interaction

Alcohol and drug synergism

Combination of alcohol and drugs

Combined action alcohol and drugs

Combined effects of alcohol and drugs

Mixed effects of alcohol and drugs

Synergistic effects of alcohol and drugs

Place I (a) Combined effects of alcohol T519 X45 T509 &X44

9 (b) and drugs

MOD II Ingested alcohol and drugs F109 T509

Accident

Interpret I(a) as alcohol poisoning and drug poisoning. Code the nature of injury and external cause for the alcohol and drugs. Precede the E-code for the drugs with an ampersand. In Part II, code the ingested alcohol as indexed. Code nature of injury for drugs as last entry.

Place I (a) Alcohol ingestion F109

9 (b) Barbiturate intoxication T423 &X41

Code I(a) alcohol ingestion as indexed and code the nature of injury and external cause for barbiturate intoxication on I(b).

Place I (a) Alcoholism F102

9 II Alcohol and barbiturate T519 X45 T423 &X41

MOD intoxication

Accident

Code alcoholism as indexed in Part I. Code the nature of injury and external cause for the alcohol and barbiturate intoxication in Part II. Precede the E-code for the drug with an ampersand.

Place I (a) Barbiturate toxicity T423 &X61

9 II Barbiturate and T423 T519 X65

MOD alcohol intoxication

Suicide

Code I(a) nature of injury for barbiturate T423 and external cause code X61 for suicidal barbiturate toxicity. Precede the E-code for barbiturate with an ampersand. Code the nature of injury and external cause for barbiturate and alcohol intoxication as indexed Part II.

Place I (a) Poisoning by alcohol T519 &X45

9 II Toxic levels of heroin and T401 X44 T424

flunitrazepam

Code I (a) nature of injury for alcohol, T519 and external cause X45. Precede the E-code for alcohol with an ampersand. Code the nature of injury and external cause for the heroin and flunitrazepam in Part II.

5. Intoxication (acute) NOS

When intoxication (acute) NOS is reported, code the nature of injury code for alcohol as indexed and the appropriate external cause for alcohol poisoning.

When intoxication (acute) NOS is reported “due to” drugs or poisonous substances, code the intoxication to the nature of injury code for the first substance reported in the “due to” position.

Exception:

Intoxication (acute) NOS “due to” drug(s) with indication the drug was being given for therapy.

Place I (a) Intoxication T519 &X45

Code intoxication as indexed to T519 and code the external cause code for alcohol poisoning X45. Precede the external cause code with an ampersand.

Place I (a) Acute intoxication T404

9 (b) Darvon & alcohol poisoning T404 &X62 T519 X65

MOD II

Suicide

Code I(a) T404, the nature of injury code for darvon since this is the first substance reported in the “due to” position. Code I(b) to the nature of injury and external cause code for darvon poisoning and alcohol poisoning. Precede the external cause code for darvon poisoning with an ampersand. Do not ampersand external cause code for alcohol poisoning.

Place I (a) Intoxication T58

9 (b) Carbon monoxide inhalation T58 &X47

MOD II

Accident

Code I(a) T58, the nature of injury for the substance (carbon monoxide) reported in “due to” position. Code I(b) to the nature of injury and external cause code for carbon monoxide inhalation. Precede the external cause code with an ampersand.

NOTE: See Appendix H for additional drug examples.

R. Complications of medical and surgical care (Y40-Y84)

Code any complication, abnormal reaction, misadventure to patient, or other adverse effect that occurred as a result of or during medical care except obstetrical procedures to the appropriate category in Chapters I-XIX, but take into account the medical care if it modifies the code assignment. Assign the appropriate external cause (E-code) pertaining to the medical care regardless of whether the complication is classified to Chapters I-XVIII or to Chapter XIX.

The E-code distinguishes between:

1. Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40-Y59).

2. Misadventures to patients during surgical and medical care (Y60-Y69).

3. Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure (Y83-Y84).

Use of ampersand (More than one instruction may apply)

1. Always precede the condition that necessitated the medical or surgical care with an ampersand the first time it is reported. Generally, the first condition on the lowest used line will be the reason for medical care.

I (a) Pneumonia J958

(b) Surgery Y839

(d) Lung cancer &C349

2. Precede the external cause (Y40-Y84) with an ampersand if the complication is classified to Chapter XIX (T80-T88).

I (a) Pulmonary embolism T817

(b) Surgery &Y839

3. Precede the first complication with an ampersand if the complication is classified to Chapter I-XVIII and the condition requiring medical or surgical care is NOT reported.

I (a) Renal failure &N19

(b) Drug therapy Y579

4. If the medical or surgical care was administered for an injury, precede the code for the external cause of the injury with an ampersand.

I (a) Pneumonia J958

Place (b) Surgery Y839

9 (c) Fracture of hip S720

(d) Fall &W19

5. If two or more conditions for which the medical or surgical care could be administered are reported and the reason for treatment cannot be determined, precede the first condition with an ampersand.

I (a) Pneumonia J958

(b) Surgery Y839

II Lung cancer, gastric ulcer &C349 K259

6. If the medical care was administered for diagnostic purposes, precede the code for the condition that was found or confirmed by the diagnostic finding with an ampersand the first time it is reported.

I (a) Cerebral edema G978

(b) Cerebral arteriogram Y848

1. Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40-Y59)

a. Complications of drugs

Although almost any condition reported due to drug therapy is regarded as a complication, there are a few diseases that are not considered complications.

The drug therapy (Y40-Y59) is not coded when there is no evidence of a complication.

Interpret “due to drug therapy” as a condition(s) on an upper line with drug therapy as the first condition on the next lower line.

(1) The following are not regarded as complications of drug therapy.

(a) These conditions due to drug therapy:

Infectious and parasitic diseases A000-A309, A320-A329, A360-A399, A420-

A449, A481-A488, A500-A690, A692-B199,

B250-B349, B500-B942, B949

(EXCEPT: Antineoplastic drugs Y431-Y433;

Immunosuppressive agents Y434)

B200-B24

Neoplasms C000-D45, D47-D489

Diabetes E10-E14 (EXCEPT: Steroids Y425, Y427)

Hemophilia D66-D682

Alcoholic disorders E244, E52, F101-F109, G312, G405, G621,

G721, I426, K292, K700-K709, K852,

K860, L278, R780, R826, R893

Rheumatic fever or rheumatic heart I00-I099

disease

Arteriosclerosis and arteriosclerotic

conditions

Influenza J09-J118

Hernia K400-K469

Congenital malformations Q000-Q999

This is not an all inclusive list.

I (a) Lung cancer C349

(b) Drug therapy

Since lung cancer is not considered a complication of drug therapy, no code is assigned for I(b).

I (a) Pancytopenia D619

(b) Lung cancer chemotherapy C349

Do not code the chemotherapy since there is no reported complication. Lung cancer is the first condition on the next lower line.

(b) Any condition stated as congenital, familial, hereditary, idiopathic or conditions with a duration that predates the drug therapy.

I (a) Congenital cardiomyopathy I424

(b) Drug therapy

Do not code the drug therapy since conditions stated as congenital cannot be considered as complications.

I (a) Nephritis 6 months N059

(b) Drug therapy 2 months

Reject 1

Do not code the drug therapy on I(b). The nephritis cannot be considered as a complication since it occurred prior to the drug therapy.

(2) Code any condition classifiable to Chapters I-XVIII that could result from a drug, medicament, or biological substance (including anesthesia) known or presumed to have been properly administered to the appropriate category in these chapters.

If the Classification provides a code for the condition reported as “due to drug” or “drug induced,” use this code. If no provision is made for the condition reported as “due to drug” or “drug induced,” code to the unspecified code for the condition.

When a condition classifiable to Chapters I-XVIII is reported due to a drug reaction (named drug) NOS, e.g., insulin reaction, code the condition as indexed and code the drug reaction to the external cause code.

Classify only those complications that cannot be assigned to Chapters I-XVIII to Chapter XIX (T80.-, T88.-).

I (a) Respiratory and cardiac arrest &R092 I469

(b) Local anesthesia reaction Y483

Code the conditions reported on I(a) as complications of local anesthesia since the local anesthesia is presumed to have been properly administered. Precede the first complication with an ampersand. Since a complication is reported, assign only an external cause on I(b) indicating Adverse effect in therapeutic use.

I (a) Drug reaction T887 &Y400

(b) Penicillin

Code the drug reaction on I(a) to nature of injury and external cause since no specified complication is reported. Precede the E-code with an ampersand. Do not enter a code for penicillin on I(b) since it was coded on I(a).

I (a) Encephalitis &G040

(b) Measles vaccination Y590

Code the encephalitis as a complication of the measles vaccine since the measles vaccine is presumed to have been properly administered. Encephalitis is indexed following vaccination or other immunization procedure. Precede the complication (G040) with an ampersand. Code the measles vaccination to Y590, Adverse effect in therapeutic use.

I (a) Pulmonary embolism I269

(b) Estrogen to control excessive Y425 &N920

Code the pulmonary embolism as a complication of the estrogen since the estrogen is presumed to have been properly administered. Code the estrogen as Adverse effect in therapeutic use and excessive menses as indexed. Precede the code for excessive menses with an ampersand to indicate the condition requiring treatment.

(3) Unless there are indications to the contrary, assume the drug, medicament, or biological substance was used for medical care purposes and was properly administered in correct dosage. Do not make this assumption if:

• The drug was one which is not used for medical care purposes, e.g., LSD or heroin,

• It was an analgesic, sedative, narcotic or psychotropic drug (or combination thereof) or drug NOS AND the certifier indicated the death was due to an “accident” “suicide” or it occurred under “undetermined circumstances ,”

• One or more of these drugs was taken in conjunction with alcohol

Code to poisoning (refer to Section V, Part Q, 2, Poisoning by drugs).

Place I (a) Respiratory failure J969

9 (b) Ingestion of mixed sedatives T426 &X41

MOD

Accident

Code I(a) as indexed. Code I(b) nature of injury and external cause code for accidental poisoning by mixed sedatives. Code as poisoning since the drug is a sedative and the certifier indicated the death was due to an accident. Precede the E-code with an ampersand.

Place I (a) Cerebral anoxia G931

9 (b) Ingestion of barbiturates T423 &X41

II Had been drinking F109

Code I(a) as indexed. Code I(b), accidental ingestion of barbiturates since the drug is a sedative and it was taken in conjunction with alcohol. Precede the E-code with an ampersand. Code Part II as indexed.

(4) When the condition for which the drug is usually administered is reported elsewhere on the certificate, code this condition as indexed, preceded by an ampersand to identify the condition requiring treatment.

I (a) Hemorrhage K922

(b) Ulcer of stomach K259

II Scleroderma &M349

The ulcer of the stomach is the complication of the cortisone therapy. Code the E-code for cortisone on I(c). Since cortisone is used in treatment of scleroderma, precede this condition with an ampersand.

When a complication occurs as the result of a drug being given in treatment and the condition requiring the drug is not reported elsewhere on the certificate, do not assume a disease condition.

When a complication classifiable to Chapters I-XVIII occurs as the result of a drug being administered in therapeutic use and the condition requiring the treatment is not reported, place an ampersand preceding the code for the complication.

I (a) Renal failure &N19

(b) Ingested antidiabetic drug Y423

The renal failure on I(a) is the complication of the antidiabetic drug. Code the E-code for antidiabetic drug on I(b). Do not assume a disease condition requiring therapy even though antidiabetic drug is one used in the treatment of diabetes. Precede the complication with an ampersand.

(5) “Drug induced” complications

When a condition is stated to be “drug induced,” consider the condition to be a complication of drug therapy, unless otherwise indicated. Code as follows:

(a) If the complication is classified to Chapter I-XVIII, code the E-code for the drug, followed by the code for the complication.

I (a) Drug induced aplastic anemia Y579 D611

II Carcinoma of lung &C349

Code I(a) Y579, complication of an unspecified drug, and the “drug induced aplastic anemia” as indexed. Ampersand the carcinoma of lung as the condition requiring treatment.

I (a) Drug induced polyneuropathy Y579 &G620

Code I(a) Y579, complication of an unspecified drug, and the “drug induced polyneuropathy” as indexed. Place an ampersand preceding the code for the complication.

(b) If the complication is classified to Chapter XIX, code the nature of injury code for the complication followed by the E-code for the drug. Place an ampersand preceding the E-code.

I (a) Chloramphenicol induced reaction T887 &Y402

(b) Septicemia &A419

Code I(a) as a complication of the drug (named). Code the nature of injury for the complication followed by the E-code for the named drug. Place an ampersand preceding the E-code and the septicemia to indicate the condition requiring treatment.

(6) “Intoxication by drug” due to drug therapy

When “intoxication by drug” is reported or indicated to be treatment for a condition or due to drug therapy, consider these to be complications of drug therapy, not poisoning.

I (a) Cardiac arrest I469

(b) Digitalis intoxication T887 &Y520

Code the digitalis intoxication as drug therapy since it is indicated as treatment for a condition by its position on the record. Code the intoxication as indexed under Intoxication, drug, correct substance properly administered and the E-code for digitalis.

(7) Gastric Hemorrhage as a Complication of Steroids, NSAIDS, Aspirin

When gastric hemorrhage is reported as the first condition on the lowest used line in Part I, and aspirin, steroids or NSAIDS are reported elsewhere on the certificate, consider the gastric hemorrhage as a complication of drug therapy and code as indexed. Code the appropriate e-code for the drug to the adverse effect in therapeutic use (Y40-Y59). If reported, ampersand the condition for which the drug was administered.

(8) Combined effects of two or more drugs

When a complication is reported due to the combined effects of two or more drugs, code the complication as indexed. On the next lower line, code the appropriate E-code (Y400-Y599). To determine the appropriate E-code, refer to the column for “Adverse effect in therapeutic use” in the Table of drugs and chemicals. (refer to Section V, Part R, 1 (3) when coded as poisoning)

(a) When the drugs are classified to different fourth characters of the same three-character category, code the appropriate E-code with the fourth character for “other.”

I (a) Cardiac arrest I469

(b) Valium and sleeping pills Y478

Code I(b) to the appropriate E-code for the combined effects of two drugs in therapeutic use classified to the same three-character category.

(b) When the drugs are classified to different three-character categories, code the E-code to Y578, “Other drugs and medicaments.”

I (a) Congestive heart failure I500

(b) Cor pulmonale &I279

II Hemorrhage from anticoagulant R5800 Y578

and aspirin

Code Y578, the appropriate E-code for combined effect of two drugs in therapeutic use classified to different three-character categories.

(9) Complications of chemotherapy

(a) When a complication of chemotherapy is reported, code the complication as indexed and Y579 unless a malignancy is reported on the certificate. When the complication is classified to Chapters I-XVIII and the reason for the chemotherapy is not reported, precede the complication with an ampersand.

I (a) Aplastic anemia &D611

(b) Chemotherapy Y579

Code I(a), aplastic anemia due to drugs (D611) and code I(b) Y579, adverse effect of unspecified drug in correct usage. Precede the complication with an ampersand.

(b) When a complication of chemotherapy is reported with mention of a malignancy on the certificate, consider the chemotherapy to be antineoplastic drugs and code E-code Y433.

I (a) Purpura D692

(b) Chemotherapy Y433

Code I(a) as indexed. Consider the chemotherapy on I(b) as antineoplastic drugs and code Y433. Ampersand the leukemia as the condition requiring treatment.

(10) Complications of immunosuppression

Immunosuppression can be drug therapy or a complication of drug therapy. Code immunosuppression as drug therapy unless reported due to a drug, then code as a complication of the drug (D849). If the drug is not reported elsewhere on the certificate, code Y434 for the immunosuppressive drug.

I (a) Pneumonia and sepsis J189 A419

(b) Immunosuppression D849

(d) &C719

Since the immunosuppression is due to chemotherapy, consider as a complication. Ampersand the carcinoma of brain as the condition requiring treatment.

I (a) Immunosuppression D849

(b) Vancomycin Y408

Since the immunosuppression is due to a drug, consider as a complication. Ampersand the acute bacterial endocarditis as the condition requiring treatment.

I (a) Infection B99

(b) Immunosuppression for Y434

Consider the infection as a complication of drug therapy (immunosuppression) on I(b). Ampersand the carcinoma of prostate as the condition requiring treatment.

I (a) Cardiorespiratory arrest I469

(b) Sepsis A419

(d) Rheumatoid vasculitis &M052

Consider the sepsis as a complication of drug therapy (immunosuppression) on I(c). Ampersand the rheumatoid vasculitis as the condition requiring treatment.

I (a) Sepsis A419

(b) Immunosuppression Y427

II Steroid therapy

Consider the sepsis as a complication of drug therapy (immunosuppression) on I(b). Code external cause code to steroids, the immunosuppressive drug reported elsewhere on the certificate. Code and ampersand Disease, kidney, as the condition for which the renal transplant was performed and the condition requiring the immunosuppressive drug.

I (a) Respiratory arrest R092

(b) Septicemia A419

II Renal transplant &N289

Consider the septicemia as a complication of drug therapy (immunosuppression) on I(c). In Part II, code and ampersand Disease, kidney, as the condition for which the renal transplant was performed and the condition requiring the immunosuppressive drug.

I (a) Bacteremia A499

(b) Immunosuppression Y434

(c)

II Idiopathic thrombocytopenia purpura &D693

Consider the bacteremia as a complication of drug therapy (immunosuppression) on I(b). Ampersand the idiopathic thrombocytopenia purpura as the condition requiring treatment.

I (a) Cardiac arrest I469

(b) ASHD I251

(c)

II DM, AS, immunosuppression E149 I709

Do not enter a code for the immunosuppression since there is not a reported complication.

(11) Drugs administered for one year or more

When a complication is reported due to a drug being administered for one year or more, consider the drug was given on a continuing basis. Code as a current complication; do not code as sequela.

I (a) Hypercorticosteronism E242

(b) Steroids - 6 years Y427

Consider the steroids as being administered on a continuing basis for six years. Code as a current complication of the drug. Code I(a) Hypercorticosteronism, correct substance properly administered (E242).

2. Surgical procedures as the cause of abnormal reaction of the patient or later complication (Y83)

a. Complications of surgical procedures

Although almost any condition reported due to surgery is regarded as a complication of surgery, there are a few diseases that are not considered complications. The surgical procedure (Y83) is not coded when there is no evidence of a surgical complication.

Interpret “due to surgery” as a condition(s) on an upper line with a surgical procedure as the first condition on the next lower line.

(1) The following are not regarded as complications of surgical procedures:

(a) These conditions reported due to surgery:

Infectious and parasitic diseases A000-A309, A320-A329, A360-A399,

A420-A449, A481-A488, A500-A690,

A692-B349, B500-B978

Neoplasms C000-D489

Hemophilia D66, D67, D680, D681, D682

Diabetes E10-E14

Alcoholic disorders E52, E244, F101-F109, G312, G405,

G621, G721, K860, I426, K292, K700-

K709, K852,L278, R780, R826, R893

Rheumatic fever or I00-I099

rheumatic heart disease

Hypertensive diseases I11-I139, I150, I159

Coronary artery disease

Coronary disease I251

Ischemic cardiomyopathy I255

Chronic or degenerative I514

myocarditis

Arteriosclerosis and

arteriosclerotic conditions except

those classified

to I219

Calculus or stones of any

type or site

Influenza J09-J118

Hernia except ventral K400-K429

(incisional) K440-K469

Diverticulitis K570-K579

Rheumatoid arthritis M050-M089

Collagen diseases M300-M359

Congenital malformations Q000-Q999

This is not an all inclusive list.

I (a) Myocardial infarction I219

(b) Arteriosclerosis I709

Since arteriosclerosis is not accepted as a complication of surgery, do not code the surgery.

I (a) Diabetic gangrene E145

(b) Leg amputation

Do not code the leg amputation (surgery) since there is no indication of a surgical complication.

I (a) Pneumonia J189

(b) Brain tumor removal D432

Do not code the removal since there is no complication. Brain tumor is the first condition on the next lower line.

(b) Do not accept conditions with a duration which predates the surgery

I (a) MI 2 weeks I219

(b) Surgery 2 days

Reject 1

Do not code the surgery on I(b). Since the MI occurred before the surgery was performed it cannot be a complication.

(2) When a condition reported due to a named surgical (operative) procedure can be considered as a complication or abnormal reaction, code as follows:

STEP 1: Determine if the complication is in the Index qualified by the named surgery reported

I (a) Lymphedema I972

(b) Postmastectomy Y836

Code I(a) using Step 1

Lymphedema

- postmastectomy I97.2

I (a) Hemorrhage T828

(b) Coronary artery bypass graft &Y832

Code I(a) using Step 1

Hemorrhage

- due to or associated with

- - device, implant or graft

- - - heart NEC T82.8

“Coronary” is not indexed, but is located in the heart; therefore, heart can be used in place of coronary.

NOTE: Before continuing to STEP 2 (below), it is important to determine the nature of the named surgery.

I (a) Hemorrhage T828

(b) Cardiac revascularization &Y832

Revascularization is defined as the re-establishment of adequate blood supply to a part, by means of a vascular graft. Code I(a) as indexed:

Hemorrhage

- due to or associated with

- - device, implant or graft

- - - heart NEC T82.8

STEP 2: If the Index does not qualify the complication with the named surgery, determine if the complication is indexed under Complications (from) (of), surgical procedure.

I (a) Hemorrhage T810

(b) Postlaminectomy &Y836

The Index does not qualify hemorrhage as postlaminectomy. Code I(a) as indexed:

Complications (from) (of)

- surgical procedure

- - hemorrhage or hematoma (any site) T81.0

Code I(b), as indexed under Complication, laminectomy.

I (a) Intestinal obstruction K913

(b) Colostomy Y833

Code I(a) as indexed

Complications (from) (of)

- surgical procedure

- - intestinal obstruction K91.3

Code I(b), surgery, as indexed under Complications, colostomy. Code I(c), ulcerative colitis, as indexed and precede with an ampersand indicating the reason for the surgery.

STEP 3: If the Index does not qualify the complication with the named surgery nor is the complication indexed under Complications (from) (of), surgical procedures, determine if the named surgery is indexed under Complications (from) (of).

I (a) Stroke T828

(b) Coronary artery bypass &Y832

The Index does not qualify stroke with coronary artery bypass nor is stroke indexed under Complications, surgical procedures; therefore, code I(a) using Step 3:

Complications (from) (of)

- coronary artery (bypass) graft

- - specified NEC T82.8

Stroke is neither an infection nor an inflammation nor mechanical; therefore, select “specified NEC.”

I (a) MI T828

(b) Postfemoral bypass graft &Y832

Code I(a) as indexed

Complications (from) (of)

- graft

- - femoral artery (bypass) - See Complications, graft, arterial

Complications (from) (of)

- graft

- - arterial

- - - specified NEC T82.8

Code I(b), Y832, as indexed under Complication, graft. Precede the E-code (Y832) by an ampersand.

I (a) Cerebral embolism T858

(b) Bypass &Y832

Code I(a) as indexed

Complications (from) (of)

- bypass (see also )

Complications (from) (of)

- graft

- - specified NEC T85.8

Code I(b), Y832, as indexed under Complications, bypass. Precede the E-code (Y832) by an ampersand.

I (a) Anemia T858

(b) Gastrointestinal bypass &Y832

Code I(a) as indexed

Complications (from) (of)

- bypass (see also )

Complications (from) (of)

- graft

- - intestinal tract

- - - specified NEC T85.8

Code I(b), Y832, as indexed under Complications, bypass. Precede the E-code (Y832) by an ampersand. Code I(c), Diverticulitis, K579, as indexed. Precede the code (K579) by an ampersand to indicate the reason for surgery.

(3) When a condition that is

(a) reported due to a named surgery cannot be assigned a code using STEP 1- STEP 3 or

(b) reported due to a surgery (operation) (of a site) NOS, and can be considered as a complication or abnormal reaction, code as follows:

STEP 4: Determine if the complication is in the Index, qualified:

(a) as reported

(b) with any term meaning “due to” surgery (see Section II, Part C, 2, a, “Due to” written in or implied)

(d) as postoperative or postsurgical

(e) as postprocedural

(f) during or resulting from a procedure, so stated

(g) resulting from a procedure, so stated

I (a) Pulmonary insufficiency following &J952

(b) Surgery Y839

Code I(a) as reported using Step 4 (a)

Insufficiency

- pulmonary

- - following

- - - surgery J952

Precede the code J952 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.

I (a) Hypothyroidism E890

(b) Thyroid surgery Y839

Code I(a) using Step 4 (b). Refer to “due to” list in Section II, Part C, 2, a, “Due to” written in or implied.

Hypothyroidism

- due to

- - surgery E890

Thyroid surgery is equivalent to surgery NOS.

I (a) Cardiac insufficiency T818

(b) Surgery &Y839

Code I(a) using Step 4 (c)

Insufficiency

- cardiac

- - complicating surgery T818

Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC. Precede the E-code (Y839) by an ampersand.

I (a) Pneumonia &J958

(b) Surgery Y839

Code I(a) using Step 4 (d). Indexed as Pneumonia (see also ).

Pneumonitis

- postoperative J958

Precede the code J958 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.

I (a) Renal failure &N990

(b) Surgery Y839

Code I(a) using Step 4 (e)

Failure

- renal

- - postprocedural N99.0

Precede the code N990 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.

I (a) Cerebral anoxia &G978

(b) Surgery Y839

Code I(a) using Step 4 (f)

Anoxia

- cerebral

- - during or resulting from a procedure G97.8

Precede the code G978 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.

I (a) Anoxic brain damage &G978

(b) Surgery Y839

Code I(a) using Step 4 (g)

Damage

- brain

- - anoxic

- - - resulting from a procedure G97.8

Precede the code G978 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical procedure NEC.

STEP 5: If the Index does not provide for the complication qualified with any of the terms defined in the previous steps, determine if the complication is indexed under Complications (from)(of), surgical procedure.

NOTE: If a “named” surgery is reported, this step has already been completed in Step 2.

I (a) Hyperglycemia &E891

(b) Surgery Y839

Code I(a) as indexed

Complications (from) (of)

- surgical procedure

- - hyperglycemia E89.1

Precede the code E891 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.

NOTE: Do not apply Step 6 when assigning a complication code for conditions classified to R00-R99.

STEP 6: If the Index does not provide for the complication as above, determine if:

(a) the site of the complication is in the Index under Complications (from) (of), surgical procedure

(b) the system in which the complication occurred (based upon the code assigned in the Index) is in the Index under Complications (from)(of), surgical procedure.

I (a) MI T818

(b) Surgery &Y839

Code I(a) using Step 6 (a)

Complications (from)(of)

- surgical procedure

- - cardiac T81.8

The site of a myocardial infarction is the muscle tissue of the heart which is synonymous with cardiac. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC. Precede the E-code with an ampersand.

I (a) Uremia &N998

(b) Surgery Y839

Code I(a) using Step 6 (b)

Complications (from) (of)

- surgical procedure

- - genitourinary

- - - specified NEC N99.8

Uremia NOS is indexed to N19 which indicates this condition is a specified disease in the genitourinary system.

I (a) Mesenteric embolism K918

(b) Gallbladder surgery Y839

Code I(a) using Step 6 (b)

Complications (from)(of)

- surgical procedure

- - digestive system

- - - specified NEC K91.8

Mesenteric embolism is indexed to K550 which indicates that this condition is a specified disease in the digestive system.

STEP 7: When a reported complication cannot be classified to a system which is indexed, code to T818, other complications of procedures, not elsewhere classified.

I (a) Anemia T818

(b) Surgery &Y839

Anemia is not indexed as due to surgery or as postoperative. Anemia is a disease of the blood-forming organs and neither the term nor the body system is indexed under Complication (from) (of), surgical procedure.

Code I(a) as indexed

Complications (from)(of)

- surgical procedure

- - specified NEC T81.8

Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC. Precede the E-code with an ampersand.

I (a) Cardiac arrest I469

(b) Brain death T818

Code line I(b) using Step 7. Brain death is not a codable condition but can be a complication of surgery.

Complications (from) (of)

- surgical procedure

- - specified NEC T818

Code I(c) surgery, Y839, as indexed under Complication, surgical operation NEC. Precede the E-code with an ampersand.

b. Condition necessitating surgery

(1) When a complication of surgery is reported and the underlying condition which necessitated the surgery is stated or implied, place an ampersand (&) preceding this condition to indicate the reason for surgery.

I (a) Pulmonary embolism T817

(b) Surgery for &Y839

Code the pulmonary embolism as the complication, Y839 for the surgery, and precede the code for gangrene with an ampersand to identify the reason for surgery. Precede the surgery code with an ampersand since the complication is coded to Chapter XIX.

(2) When the condition necessitating the surgery is not stated or implied and the complication is classifiable to Chapters I-XVIII, place an ampersand preceding the code for the complication.

I (a) Renal failure &N990

(b) Surgery Y839

Code I(a), renal failure, N990, as the complication of the surgery (Y839) on I(b). Precede the N990 with an ampersand since it is classified to Chapter I-XVIII and the reason for the surgery is not reported.

(3) Do not ampersand a condition necessitating surgery unless a complication of the surgical procedure is coded.

I (a) ASHD I251

II SP mastectomy, Cancer of breast C509

Do not precede the reason for surgery, C509 with an ampersand since no complication of the mastectomy is reported.

(4) When the condition that necessitated the surgery is not reported, but the organ or site is implied by the operative term, code disease of the organ or site.

I (a) Septic complications of open heart surgery I519

Even though no complication is reported, the reason for treatment can still be assigned. Code Disease, heart since the surgery was of the heart.

Exception:

Appendectomy

Code appendicitis (K37) when appendectomy is the only operative procedure reported. If appendectomy is reported with other abdominal or pelvic surgery, assume the appendectomy to be incidental to the other surgery and do not code K37.

Use the following codes when these surgical procedures are reported and the condition necessitating the surgery is not reported:

Aorta (with any other vessel NEC) bypass or graft........................ I779

Aorta coronary bypass or graft.................................................... I251

Atrio-ventricular shunt............................................................... G919

Bariatric surgery........................................................................ E668

Billroth (I or II)....................................................................... K3190

Brock valvulotomy.................................................................... Q223

Cardiac revascularization............................................................ I251

Carotid endarterectomy.............................................................. I679

Choledochoduodenostomy.......................................................... K839

Cholecystectomy....................................................................... K829

Cholelithotomy.......................................................................... K802

Colostomy................................................................................ K639

Coronary artery bypass graft (CABG)........................................... I251

Coronary endarterectomy........................................................... I251

Coronary revascularization.......................................................... I251

Endarterectomy (artery) (aorta).................................................. I779

Femoral bypass......................................................................... I779

Femoral-popliteal bypass............................................................ I779

Gastrectomy........................................................................... K3190

Gastric stapling.......................................................................... E668

Gastroenterostomy.................................................................... K929

Gastro-intestinal surgery NOS..................................................... K929

Gastrojejunostomy.................................................................... K929

Gastrojejunectomy.................................................................... K929

Herniorrhaphy................................................................. code hernia

Hip fixation................................................................................ S720

Hip pinning................................................................................ S720

Hip prosthesis........................................................................... M259

Hip replacement....................................................................... M259

Hysterectomy........................................................................... N859

Ileal conduit.............................................................................. N399

Ileal loop.................................................................................. N399

Iliofemoral bypass...................................................................... I779

Lobectomy-when indicating lung................................................ J9840

Mammary artery(internal) implant............................................... I251

Nephrectomy............................................................................ N289

Revascularization of heart........................................................... I251

Revascularization, myocardial..................................................... I251

T and A..................................................................................... J359

Thoracoplasty............................................................................ J989

Tonsillectomy............................................................................ J359

Ureterosigmoid bypass.............................................................. N399

Ureterosigmoidostomy............................................................... N399

Vein stripping............................................................................. I839

Ventricular peritoneal shunt........................................................ G919

Vineberg operation..................................................................... I251

When the condition that necessitated the surgery is not reported, do not assume a disease condition for surgical procedures such as:

amputation pelvic exenteration

arteriovenous shunt portocaval shunt

chordotomy radical neck dissection

craniotomy rhizotomy

cystostomy sympathectomy

D & C tracheotomy

gastrostomy tracheostomy

laminectomy tubal ligation

laparotomy vagotomy

lobectomy NOS vasectomy

lobotomy vas ligation

If one of these types of procedures is the only entry on the certificate, code R99.

When the following complications of surgery are reported and the reason for the surgery is not reported, use the following codes as the reason the surgery was performed:

Reason for Surgery
Code

Postsurgical hypothyroidism E079

Postsurgical hypoinsulinemia K869

Postsurgical blind loop syndrome K639

Other and unspecified

postsurgical malabsorption K639

I (a) Postsurgical blind loop syndrome Y839 K912 &K639

When a complication is reported due to:

“Surgery” with the underlying condition that necessitated the surgery stated, code:

the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required, and the underlying condition necessitating the surgery preceded by an ampersand.

I (a) Hemorrhage T810

(b) Surgery &Y839

Code I(a) as postoperative hemorrhage (T810). Code the external cause code for the surgical procedure and precede by an ampersand. Code C349, cancer of lung and precede by an ampersand to identify the stated underlying condition for which surgery was performed.

I (a) Pulmonary hemorrhage R048

(b) Lung cancer &C349

II Pneumonia due to surgery for J958 Y839 R048

pulmonary hemorrhage

Code line I(a) and (b) as indexed. Precede cancer of lung with an ampersand to indicate the underlying reason for which surgery was performed. Since the first entry in Part II, pneumonia, is reported due to surgery, code as a complication of surgery.

“Surgery” with the condition which necessitated the surgery not stated and only one condition for which surgery could have been performed is reported, code:

the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required. Since only one condition for which the surgery could have been performed is reported, code the condition and precede with an ampersand to identify the reason for the surgery.

I (a) Mesenteric thrombosis K918

(b) Surgery Y839

II ASHD &I251

Code mesenteric thrombosis as the complication of the surgery and code Y839 for the surgery. Since ASHD is the only condition on the certificate for which surgery could have been performed, precede the code for this condition by an ampersand.

“Surgery” with the condition which necessitated the surgery not stated and two or more conditions for which surgery could have been performed are reported, code:

the complication to Chapters I-XIX and the surgery to appropriate external cause code (Y83-) preceded by an ampersand, if required. Ampersand the first mentioned condition for which the surgery could have been performed.

I (a) Wound dehiscence T813

(b) Surgery &Y839

II Cancer of lung, gastric ulcer &C349 K259

Code I(a), wound dehiscence, T813, as the complication of the surgery and code I(b), surgery, Y839. Code Part II as indexed and precede the code for cancer of lung by an ampersand since it is the first mentioned condition for which the surgery could have been performed.

“Surgery” without indication of the condition which necessitated the surgery, code:

the complication to Chapters I-XIX, and the surgery to appropriate external cause code (Y83-) only. If the complication is classifiable to Chapters I-XVIII, precede the code for the complication with an ampersand.

I (a) Shock & hemorrhage T811 T810

(b) Surgery &Y839

Code I(a), shock and hemorrhage, T811 T810, both as complications of the surgery. Code I(b), surgery, Y839 and precede the code by an ampersand.

Surgical procedure such as aneurysmectomy, cholelithotomy, hemorrhoidectomy or herniorrhaphy which indicates the condition for which the surgery was performed, code:

the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required, and code the condition implied by the surgery following the external cause code for the surgery. Place an ampersand preceding the code for the condition.

I (a) CHF I978

(b) Cholelithotomy Y838 &K802

Code I(a), CHF (congestive heart failure), as the complication of surgery. Code I(b), cholelithotomy, Y838 K802. Cholelithotomy indicates cholelithiasis (K802) was the condition for which surgery was performed. Precede K802 by an ampersand.

Surgical procedure that indicates an organ or site with one related condition for which the surgery could have been performed, code:

the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required. Code the condition for which surgery could have been performed and precede with an ampersand.

I (a) MI T818

(b) Gastrectomy &Y836

II Bleeding gastric ulcer &K254

Code I(a), MI, as the complication of the surgery. Code I(b), gastrectomy, Y836, as indexed and precede with an ampersand. Code Part II, bleeding gastric ulcer, as indexed and precede with an ampersand to indicate it was the condition for which surgery was performed.

I (a) Cardiac arrest T828

(b) CABG &Y832

II Heart disease &I519

Code I(a), cardiac arrest, as the complication of the surgery. Code I(b), CABG, Y832 as indexed and precede with an ampersand. Code Part II, heart disease, as indexed and precede with an ampersand to indicate it was the condition for which surgery was performed.

Surgical procedure that indicates an organ or site without a related condition for which the surgery could have been performed, code:

the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required, and code disease of the organ or site following the external cause code for the surgery. Place an ampersand preceding the code for the condition.

I (a) Cardiac arrest I469

(b) Pneumonia J958

Code I(a), cardiac arrest, as indexed. Code I(b), pneumonia, as the complication of the surgery. Code I(c), pancreatectomy, as indexed, and since the surgery indicates a disease of the pancreas, code this as the reason for surgery. Precede K869 by an ampersand.

Prophylactic or nontherapeutic surgery, code

the complication to Chapters I-XIX, and the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required. Do not assume or ampersand a disease condition. When the complication is classifiable to Chapters I-XVIII, precede the code for the complication with an ampersand.

I (a) Sepsis A419

(b) Infection T814

Code I(a), sepsis, as indexed. Code I(b), infection, as the complication of the nontherapeutic surgery. Code I(c) as a specified type of surgical operation.

c. Conditions qualified as postoperative

(1) When the following postoperative terms or a synonymous term qualifies a condition, determination must be made as to whether the condition is a surgical complication or the condition for which the surgery was performed.

p.o. postoperative status postop

post-named surgery status p.o. status postoperative

(postgastrectomy) status post-named surgery status post surgery

postop (status post gastrectomy)

(2) The following conditions are common complications of surgery. Code these conditions as postoperative complications when preceded by or followed by one of the postoperative terms except when it is stated elsewhere on the certificate as the reason the surgery was performed.

abscess hemorrhage, hematoma sepsis

adhesions infarction septicemia

aspiration infection septic shock

atelectasis occlusion shock

bowel obstruction peritonitis thrombophlebitis

cardiac arrest phlebitis, phlebothrombosis thrombosis

embolism pneumonia wound infection

fistula pneumothorax

gas gangrene renal failure (acute)

hemolysis,
hemolytic
infection

This list is not all inclusive.

(3) When “postoperative,” “postop,” “status postoperative,” etc., qualifies (preceding or following) a complication:

(a) If the complication is classified to Chapters I-XVIII, code the external cause code followed by the code for the complication.

I (a) Pneumonia postgastrectomy Y836 J958 &K3190

Code pneumonia as the complication of surgery when reported as “postoperative” or a synonymous term. Since the reason for surgery is not stated, code disease stomach and precede by an ampersand to indicate the reason for surgery.

I (a) Postgastrectomy dumping syndrome Y836 K911

(b)

Code I(a), Y836, as indexed under Complication, gastrectomy, and K911, as indexed under Syndrome, dumping. Code I(c) C169, as indexed under Neoplasm, stomach, malignant. Place an ampersand (&) preceding C169 to identify the underlying reason for surgery.

I (a) Pulmonary edema J958

(b) P.O. bowel obstruction Y839 K566

II Surgery for bowel obstruction K566

Code I(a), pulmonary edema, as the complication of surgery. Code I(b) to surgery Y839 and code bowel obstruction as indexed K566 since it is stated as the reason for surgery. Code I(c), cancer of cecum, as indexed and precede the code by an ampersand to indicate the underlying reason for surgery. Part II, do not enter a code for surgery since P.O. was reported on line (b) and a surgery code was entered there. Code bowel obstruction as indexed.

(b) If the complication is classified to Chapter XIX, code the nature of injury code followed by the external cause code.

I (a) Sepsis and anuria A419 R34

(b) P.O. peritonitis T814 &Y839

Code peritonitis as the complication as indexed under Peritonitis, postprocedural, T814. Code Y839 for the procedure. Peritonitis is considered to be a complication of surgery when reported as “postop” and not reported as the reason for surgery. Place an ampersand preceding the surgery code and the cancer of colon to identify the underlying reason for surgery.

I (a) Cardiac arrest I469

(b) Peritonitis, postop T814 &Y839

Code I(a) as indexed. Code I(b), peritonitis, as the complication, T814 and Y839 for the procedure. Peritonitis is considered a complication of surgery when reported as “status postop” and not reported as the reason for surgery. Precede the E-code with an ampersand. Code I(c), cholelithiasis, as indexed and precede the code by an ampersand to indicate the condition necessitating surgery.

I (a) MI postgastrectomy T818 &Y836

II Gastric ulcer surgery &K259

Code I(a), M.I. postgastrectomy, T818 Y836. M.I. is considered to be a complication of surgery when reported as “postoperative” and not reported as the reason for surgery. Precede the E-code with an ampersand. Code Part II, gastric ulcer, K259 as indexed and precede the code by an ampersand to indicate the condition necessitating surgery. Do not enter a code in Part II for surgery since gastrectomy was reported on I(a) and the code was entered there.

I (a) Postoperative embolism T817 &Y836

(b) Appendectomy

Code I(a), postoperative embolism, as indexed to T817 and Y836 as indexed under Complication, appendectomy. Precede the E-code with an ampersand. Code I(c), acute appendicitis, as indexed and precede the code by an ampersand to identify the underlying condition that necessitated surgery.

I (a) Heart failure I509

(b) ASHD &I251

II Thrombophlebitis, postoperative T817 &Y839

Code I(a) and I(b) as indexed. Code Part II, thrombophlebitis, postoperative, T817 Y839. Precede the E-code (Y839) by an ampersand. Thrombophlebitis is considered to be a complication of surgery when reported as “postoperative” and not reported as the condition that necessitated surgery. Precede the code on I(b), I251 (ASHD), by an ampersand to indicate the underlying condition necessitating surgery.

I (a) Pneumonia J189

(b) P.O. infection (wound) T814 &Y839

Code I(a) as indexed. Code I(b), p.o. infection (wound), T814 Y839. Precede the E-code with an ampersand. Infection is considered to be a complication of surgery when reported as “postop” and not reported as the reason for surgery. Code I(c), intestinal obstruction, K566 and precede the code by an ampersand to indicate the condition necessitating surgery.

I (a) Postoperative complication T819 &Y839

(b) Open heart surgery

Code I(a) as indexed under Complications, postoperative. Code the external cause code where the surgery is first reported, in the second position on I(a). Precede the E-code with an ampersand. Code I(c), heart disease, as indexed and precede the code by an ampersand to indicate the condition necessitating surgery.

(c) When “postoperative intestinal obstruction” (any K560-K567) is reported and no condition which could have necessitated the procedure is reported:

(i) Code the postoperative intestinal obstruction as the condition which necessitated the surgical procedure if another condition is reported due to the postoperative obstruction.

I (a) Peritonitis T814

(b) Postoperative bowel &Y839 &K566

Code I(a), peritonitis, as the complication of surgery. Code I(b), postoperative bowel obstruction Y839 K566. Precede the E-code with an ampersand. Precede the K566 with an ampersand to indicate the condition necessitating surgery.

(ii) Code the postoperative intestinal obstruction to K913 as the complication if no other condition is reported due to postoperative obstruction.

I (a) Postoperative ileus Y839 &K913

Code I(a) Y839 K913. Precede K913 by an ampersand. Consider the postoperative ileus to be the complication since no other condition is reported due to this condition.

NOTE:

(4) Status post - When status post (s/p) qualifies a condition, disregard the statement of status post and code the condition as indexed. This applies whether or not surgery is mentioned elsewhere on the certificate.

I (a) Cardiogenic shock R570

(b) Myocardial infarction I219

Code each condition as indexed. No code is entered for the surgery since no complication is reported. Assume the ischemic heart disease was the reason the CABG was performed.

I (a) S/P cardiac arrest I469

(b) Arteriosclerosis I709

II S/P gastrectomy, cancer stomach C169

Code each condition as indexed. No code is entered for the surgery since no complication is reported.

I (a) Status post MI I219

(b) ASHD I251

Code the MI as indexed.

d. Complication as first entry on lowest used line in Part I

(1) When one of the conditions listed below is reported as the first entry on the lowest used line in Part I with surgery (any) reported on same line or in Part II, code this condition as a complication of surgery.

Do not apply this instruction:

(a) When the surgery is stated to have been performed 28 days or more prior to death.

(b) When the condition on the lowest used line predates the surgery.

Acute kidney injury

Acute renal failure

Aspiration

Atelectasis

Bacteremia

Cardiac arrest (any I469)

Disseminated intravascular coagulopathy (DIC)

Embolism (any site)

Gas gangrene

Hemolysis, hemolytic infection

Hemorrhage NOS

Infarction (any site)

Infection NOS

Occlusion (any site)

Phlebitis (any site)

Phlebothrombosis (any site)

Pneumonia (J120-J168, J180-J189, J690, J698)

Pneumothorax

Pulmonary insufficiency

Renal failure (acute) NOS

Septicemia (any A400-A419)

Shock (R570-R579)

Thrombophlebitis (any site)

Thrombosis (any site)

I (a) Pneumonia J958

(b)

(c)

II Diabetic gangrene, amputation &E145 Y835

Code pneumonia as a complication of the amputation since it is the first entry on the lowest used line in Part I and surgery, not indicated to have been performed 28 days or more prior to death, is reported in Part II.

I (a) Pneumonia J189

(b) Pulmonary embolism, gastrectomy T817 &Y836

(c)

II Cancer of stomach &C169

Code pulmonary embolism as a complication of gastrectomy since it is the first entry on the lowest used line in Part I and gastrectomy, not stated to have been performed 28 days or more prior to death, is reported on the same line as the embolism.

Date of death 09/17/96

I (a) Pleural effusion J90

(b) Pulmonary embolism & pneumonia T817 J189

(c)

II &Y839

Operation block

/ 9/15/96 /

NOTE: When a date is entered in the operation block, code as if surgery was performed on that date.

Code I(a) as indexed. Code pulmonary embolism as the complication of surgery since this condition is the first condition on the lowest used line in Part I and surgery was performed less than 28 days prior to death.

I (a) Cardiogenic shock R570

(b) Hypovolemic shock T828

II Dialysis shunt hemorrhage; renal failure T828 &Y832 &N19

Code line I(a) as indexed. Code Hypovolemic shock as a complication of the dialysis shunt since it is the first entry on the lowest used line in Part I and dialysis shunt, not stated to have been performed 28 days or more prior to death, is reported in Part II. Hemorrhage reported in Part II is also a complication.

I (a) Sepsis T814

II Encephalopathy, ESRD, morbid obesity, G934 N185 E668 I890 I500 I10 &Y835 &E119

Lymphedema, CHF, HTN, CKD, Right

BKA for Diabetes II

Tobacco use: Probably

Code sepsis as a complication of the below knee amputation since it is the first entry on the lowest used line in Part I and BKA, not stated to have been performed 28 days or more prior to death, is reported in Part II. Delete the excessive codes from Part II so that only 8 remain. Since there is a complication reported, retain the surgery-related codes and delete N189 and F179.

I (a) Pulmonary infarction I269

(b)

(c)

II Cardiac catheterization

Cardiac catheterization is not classified as a surgical procedure; therefore, do not code the pulmonary infarction as a complication.

(2) When any of the conditions listed below are reported as the first entry on the lowest used line in Part I and abdominal or pelvic surgery is reported on the same line or in Part II, code complication as indexed and the surgery to appropriate external cause code (Y83-) where it is indicated on the record by the certifier.

Peritonitis

Intestinal obstruction (K560-K567)

I (a) Pneumonia J189

(b) Peritonitis K659

II Colostomy - ulcerative colitis Y833 &K519

Code intestinal obstruction on I(c) as a complication of the surgery reported in Part II, since the surgery was abdominal and there is no indication that this procedure was performed 28 days or more prior to death.

(3) When any of the conditions listed below are reported as the first entry on the lowest used line in Part I and surgery of the same site or region is reported on the same line or in Part II, code complication as indexed and the surgery to appropriate external cause code (Y83-) where it is indicated on the record by the certifier.

Hemorrhage of a site

Fistula of site(s)

I (a) Pneumonia J189

(b) Gastrointestinal hemorrhage T810

II Gastrectomy for stomach cancer &Y836 &C169

Code gastrointestinal hemorrhage as a complication of the surgery reported in Part II since the surgery was of the same region and there is no indication that surgery was performed 28 days or more prior to death.

(4) When conditions listed in paragraph d(1), (2), and (3) are reported as the first entry on the lowest used line in Part I and surgery stated to have been performed 28 days or more prior to death is reported on the same line or in Part II, code condition as indexed. Do not code as a complication of the surgery.

I (a) Congestive heart failure I500

(b) Shock R579

II Surgery performed 6 wks. ago for colon cancer C189

Code all conditions on this record as indexed. Do not code acute renal failure as a complication of surgery since the surgery was performed 28 days or more prior to death.

(5) When adhesions are reported as the first entry on the lowest used line in Part I and surgery stated to have been performed less than one year prior to death is reported on same line or in Part II, code adhesions to K918 and code the surgery to appropriate E-code (Y83-).

I (a) Septic shock A419

(b) Peritonitis K659

II Surgery - 6 mos. ago for ca. of colon Y839 &C189

Code adhesions on I(c) as a complication of surgery and code the external cause code for the surgery as the first entry in Part II. Code the condition for which surgery was performed and precede by an ampersand.

(6) When adhesions are reported as the first entry on the lowest used line in Part I and surgery stated to have been performed one year or more prior to death is reported on same line or in Part II, code adhesions to K918, Other postprocedural disorders of the digestive system and code the surgery to Y883, sequela of surgery.

I (a) Renal failure N19

(b) Intestinal obstruction K566

II Surgery - 16 months ago for diverticulitis Y883 &K579

Code adhesions on I(c) as a complication of the surgery reported in Part II. Since this surgery was performed more than 1 year ago, code Y883 for the sequela of surgery. Code diverticulitis as the condition for which surgery was performed.

e. Ill-defined condition as first entry on lowest used line in Part I

When an ill-defined condition classifiable to the following codes:

I461 (Sudden cardiac death, so described)

I959 (Hypotension, unspecified)

I99 Except occlusion and infarction (Other and unspecified disorders of circulatory system)

J960 (Acute respiratory failure)

J969 (Respiratory failure, unspecified)

P285 (Respiratory failure of newborn)

R000-R568, R590-R948, R960-R99 (Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified) is reported as the first entry on the lowest used line in Part I with surgery reported on the same line or in Part II, proceed:

(1) Code the ill-defined condition, then code the remaining conditions as if the ill-defined condition had not been reported.

I (a) Senility and MI R54 T818

II Gastrectomy &Y836 &K3190

Code senility on I(a) R54 as indexed. Then code MI as if senility had not been reported. MI is coded as the complication of the surgery reported in Part II. Gastrectomy indicates a disease of the stomach. Precede both the code for the surgery and the code for Disease, stomach, with an ampersand.

I (a) Renal failure N990

(b) Cause unknown R97

II Mastectomy Y836 &N649

Code cause unknown on I(b) as indexed, then code renal failure as the complication of the surgery reported in Part II as if cause unknown had not been reported. Code Part II, mastectomy, Y836 N649. Code Disease, breast as the condition necessitating the mastectomy and precede it by an ampersand.

Exceptions:

Code each entry as indexed when:

The first entry on the And a condition classifiable

lowest line in Part I is to one of the following

classifiable to codes is reported on the

same line or in Part II

I461 A520 I260-I4290

B24 I510-I518

B332 M349

I010-I099 P293

I110-I119 Q200-Q269

I130-I139

J960 E841

E849

J969 E841

E849

R000 Tachycardia, unspecified I010-I099 I470-I519

I110-I119 J380-J399

I130-I461

R002 Palpitations I010-I099 I130-I461

I110-I119 I470-I519

R010 Benign and innocent I010-I099 I130-I461

cardiac murmurs

R011 Cardiac murmur, I110-I119 I470-I519

unspecified

R012 Other cardiac sounds

R02 Gangrene NEC A480 E135 K410

E100-E104 E136 K412

E105 E137 K413

E106 E139 K419

E107 E140-E144 K420

E109 E145 K429

E110-E114 E146 K430

E115 E147 K439

E116 E149 K440

E117 I702 K449

E119 I709 K450

E120-E124 I730-I739 K458

E125 K352-K389 K460

E126 K400 K469

E127 K402

E129 K403

E130-E134 K409

R030 Elevated blood pressure I10-I139

reading, without

diagnosis of hypertension

The first entry on the And a condition classifiable

lowest line in Part I is to one of the following

classifiable to codes is reported on the

same line or in Part II

R040 Epistaxis C300-C319C783 I10

C910-C959 J00-J019

D023 J068-J069

D140 J300-J311

D385 J320-J348

J393-J399

R041 Hemorrhage from throat C090-C148 D141

C320-C329 D370

C783 D380

C798 J00

C910-C959 J020-J040

D000 J042-J069

D020 J311-J312

D104-D109 J350-J399

R042 Hemoptysis A162-A1690 D141-D143

R048 Hemorrhage from other C320-C349 D380-D381

sites in respiratory C780 J040-J22

passages C783 J370-J387

C910-C959 J393-J989

D020-D022

R05 Cough F453 J111

J101 J1110

J1010 R042

R060 Dyspnea A162-A1690 D381-D383

B909 D385-D386

C33-C399 J40-J989

C780-C783 P221

D142-D159

The first entry on the And a condition classifiable

lowest line in Part I is to one of the following

classifiable to codes is reported on the

same line or in Part II

R061 Stridor J385

R062 Wheezing A162-A1690 D381-D383

B909 D385-D386

C33-C399 J40-J989

C780-C783 P221

D142-D159

R064 Hyperventilation F453

R066 Hiccough F453

R090 Asphyxia T360-T659

R104 Other and unspecified R100

abdominal pain R193

R11 Nausea and vomiting J1010 J118

J108 K250-K289

J1110 K800-K820

R17 Unspecified jaundice B150-B199 C787-C788

C220-C259 K700-K839

R18 Ascites C160-C269 C796

C56 C80-C969

C784 K740-K746

C787-C788

R233 Spontaneous ecchymoses D690-D699

The first entry on the And a condition classifiable

lowest line in Part I is to one of the following

classifiable to codes is reported on the

same line or in Part II

R250 Abnormal head movements G110-G119

R251 Tremor, unspecified G20-G259

R252 Cramp and spasm G400-G419

R253 Fasciculation G510

R258 Other and unspecified G800-G839

abnormal involuntary

movements

R260 Ataxic gait A521

R261 Paralytic gait

R262 Difficulty in walking,

not elsewhere classified

R268 Other and unspecified

abnormalities of gait

and mobility

R270 Ataxia, unspecified A521

A523

G110-G119

R278 Other and unspecified A521

lack of coordination G110-G119

R290 Tetany E200-E209

R291 Meningismus J1010 J1110

J108 J118

R298 Other and unspecified G800-G839

symptoms and signs

involving the nervous and

musculoskeletal systems

The first entry on the And a condition classifiable

lowest line in Part I is to one of the following

classifiable to codes is reported on the

same line or in Part II

R300 Dysuria C600-C689 D280-D309

R301 Vesical tenesmus C790-C791 D390-D419

R309 Painful micturition, C796 N000-N999

unspecified C798 Q600-Q649

D060-D061

R31 Unspecified hematuria B508 D060-D061

B54 D280-D309

C600-C689 D390-D419

C790-C791 N000-N999

C796 Q600-Q649

C798

R32 Unspecified urinary C600-C689 D280-D309

incontinence C790-C791 D390-D419

R33 Retention of urine C796 N000-N999

C798 Q600-Q649

D060-D061

R34 Anuria and oliguria C600-C689 D280-D309

C790-C791 D390-D419

C796 N000-N999

C798 Q600-Q649

D060-D061 T795

R35 Polyuria C600-C689 D280-D309

R36 Urethral discharge C790-C791 D390-D419

R390 Extravasation of urine C796 N000-N999

R391 Other difficulties with C798 Q600-Q649

micturition D060-D061

R392 Extrarenal uremia

R398 Other and unspecified

symptoms and signs

involving the urinary

system

The first entry on the And a condition classifiable

lowest line in Part I is to one of the following

classifiable to codes is reported on the

same line or in Part II

R400 Somnolence E100 E147

R401 Stupor E107 E15

E110 K729

E117 S020-S024

E120 S026-S029

E127 S060-S099

E130 T902

E137 T905-T909

E140

R402 Coma, unspecified E100 E132-E136

E101 E137

E102-E106 E139

E107 E140

E109 E141

E110 E142-E146

E111 E147

E112-E116 E149

E117 E15

E119 E160-E162

E120 K729

E121 S020-S024

E122-E126 S026-S029

E127 S060-S099

E129 T902

E130 T905-T909

E131

R529 Pain, unspecified G547

R568 Other and unspecified A35

convulsions G400-G419

O100-O11

O13-O16

The first entry on the And a condition classifiable

lowest line in Part I is to one of the following

classifiable to codes is reported on the

same line or in Part II

R590 Localized enlarged B270-B279

lymph nodes C810-C969

R591 Generalized enlarged B24 B589

lymph nodes B270-B279 C810-C969

B588

R599 Enlarged lymph nodes, B270-B279

unspecified C810-C969

R600 Localized edema E43 N000-N058

R601 Generalized edema E877 N059

R609 Edema, unspecified E43

E877

N000-N058

R628 Other lack of expected B24

normal physiological E45

development E46

R630 Anorexia F500

R631 Polydipsia E232

N251

R64 Cachexia B24

E41

E46

R730 Abnormal glucose E100-E162

tolerance test E891

R780 Finding of alcohol in F101-F109

blood

The first entry on the And a condition classifiable

lowest line in Part I is to one of the following

classifiable to codes is reported on the

same line or in Part II

R788 Finding of other A000-A079

specified substances, A090-A499

not normally found in J13-J159

blood J180-J189

R798 Other specified abnormal E100 E127

findings of blood E101 E129

chemistry E102-E106 E130

E107 E131

E109 E132-E136

E110 E137

E111 E139

E112-E116 E140

E117 E141

E119 E142-E146

E120 E147

E121 E149

E122-E126

R799 Abnormal finding of E101 E127

blood chemistry, E107 E131

unspecified E111 E137

E117 E141

E121 E147

R80 Isolated proteinuria C900 N000-N079

D511 N170-N19

D649 N250-N289

R81 Glycosuria E100-E149

E748

R823 Hemoglobinuria B508

B54

D595-D596

The first entry on the And a condition classifiable

lowest line in Part I is to one of the following

classifiable to codes is reported on the

same line or in Part II

R824 Acetonuria E101 E127

E107 E131

E111 E137

E117 E141

E121 E147

R826 Abnormal urine levels of F101-F109

substances chiefly

nonmedicinal as to source

R893 Abnormal findings in F101-F109

specimens from other

organs, systems and

tissues

I (a) Pneumonia J189

(b) Coma R402

II Surgery for diabetic gangrene E145

Code I(a) and I(b) as indexed. Coma is reported as the first condition on the lowest used line, but diabetic gangrene is reported in Part II. Therefore, pneumonia cannot be coded as a complication of surgery. Do not enter a code for surgery since no complication is reported.

I (a) Aspiration pneumonia J690

(b) Jaundice R17

II Cholecystectomy for gallstones K802

Code I(a) and I(b) as indexed. Jaundice is reported as the first condition on the lowest used line with gallstones reported in Part II. Therefore, aspiration pneumonia cannot be coded as a complication of surgery. Code Part II, K802 (gallstones). Do not enter a code for the cholecystectomy since no complication was reported.

I (a) Sepsis A419

(b) Gangrene, pneumonia, and R02 J189 I709

II Surgery

Code I(a) and I(b) as indexed. Gangrene is reported as the first condition on the lowest used line, but arteriosclerosis is reported on the same line; therefore, pneumonia cannot be a complication of surgery. Do not enter a code for surgery since no complication is reported.

f. Relating condition for which surgery was performed to the site of the surgery

(1) When a condition of unspecified site is reported with surgery of a defined site, code the condition of unspecified site to the defined site.

I (a) Aneurysm I719

II Operation for aortic aneurysm I719

Code I(a), aneurysm of unspecified site to aortic aneurysm, I719, since the surgery is of a defined site. Code aortic aneurysm in Part II. Do not enter a code for the surgery since there is no reported complication.

I (a) Pneumonia J958

(b) Esophagectomy due to cancer Y836

Code I(c), cancer of unspecified site to esophageal cancer C159, since the surgery is of a defined site.

(2) When a condition of a site is reported with surgery of a more defined part of the site, code the condition to the more specified site.

I (a) Carcinoma colon C186

II Left colectomy

Code I(a), carcinoma colon to carcinoma left colon, C186, since the surgery is of a more specified part of the colon. Do not enter a code for the surgery since there is no reported complication.

I (a) Valvular heart disease I059 I069

II Status post mitral and aortic valve repair

Code I(a) valvular heart disease of unspecified valve to disease, mitral and aortic valves since the surgery is of specified valves. Do not enter a code for the surgery since there is no reported complication.

(3) When a condition of a site is reported with surgery for the same condition of unspecified or a less defined part of the site, code the condition to the most defined site.

I (a) Cancer of head of pancreas C250

II Pancreatectomy for cancer C250

Code I(a), cancer head of pancreas, C250. Code Part II as cancer of head of pancreas since elsewhere a more defined site was reported of the condition for which surgery was performed. Do not enter a code for the surgery since there is no reported complication.

(4) Do not apply these instructions when more than one condition or a condition of multiple specified sites which could have necessitated the surgery is reported.

I (a) Cardiac arrest I469

(b) Respiratory arrest R092

II Findings of operation: Carcinoma C80

Code I(a), I(b) and I(c) as indexed and according to neoplasm instructions. Code Part II, carcinoma, C80. Do not code the carcinoma to a more defined site since multiple specified sites are reported for which the surgery could have been performed. Do not enter a code for the surgery since there is no reported complication.

g. Complications of amputation and amputation stump

When a complication (stated or implied) occurs as a result of an amputation, code the complication to Chapters I-XIX. When the complication is classifiable to Chapters I-XVIII and the condition that necessitated the amputation is not reported, precede the code for the complication with an ampersand.

I (a) Renal failure &N990

(b) Below knee amputation of leg Y835

Code I(a), renal failure, N990 as the complication of surgery. Code I(b), below knee amputation of leg, Y835. Precede the N990 with an ampersand since it is classified to Chapter XIV and the condition that necessitated the amputation is not reported.

When there is a complication of an amputation stump, code the complication to T873-T876 or to the appropriate code in Chapters I-XVIII. (Do not use T873-T876 for “stump” of internal organs).

I (a) Infected amputation stump T874 &Y835

(b) Osteosarcoma of leg &C402

Code I(a), infected amputation stump T874 Y835. Precede the E-code, Y835, by an ampersand. Code I(b), osteosarcoma of leg, C402. Precede C402 by an ampersand to indicate the condition that necessitated the amputation.

3. Complications of medical procedures other than surgical (Y84)

Medical procedures are any type of nonsurgical procedures used in the treatment of diseases or injuries. Although almost any condition reported due to medical procedures is regarded as a complication, there are a few diseases that are not considered complications. Do not code the conditions listed under 2. a. (1) (a) and (b) in Section V, Part R as complications of medical procedures. The medical procedure (Y84) is not coded when there is no evidence of a complication. If the reason for the medical procedure is not reported, do not assume a disease condition.

Interpret “due to medical procedures” as a condition(s) on an upper line with a medical procedure as the first condition on the next lower line.

a. When a condition is reported due to a named medical procedure other than a surgical operation or is modified by a named procedure and can be considered as a complication(s) or adverse effect, code as follows:

STEP 1: Determine if the complication is in the Index qualified by the specific procedure reported.

I (a) Kidney blockage &N990

(b) Postcystoscopic procedure Y848

Code I(a) as indexed using Step 1

Block

- kidney

- - postcystoscopic or postprocedural N99.0.

Code I(b) Y848 as indexed under Complication, procedures other than surgical operation, specified NEC. Precede N990 with an ampersand.

STEP 2: If the Index does not qualify the complication with the specified procedure, determine if the procedure is indexed under Complications (from) (of).

I (a) Urinary tract infection T835

(b) Post-indwelling urinary catheter &Y846

Code I(a) using Step 2

Complications (from) (of)

- catheter (device)

- - urinary (indwelling)

- - - infection or inflammation T83.5

Select infection or inflammation since urinary tract infection is an infectious condition.

Code I(b) Y846 as indexed under Complication, catheter, catheterization (urinary). Precede the E-code with an ampersand.

I (a) Pulmonary embolism T838

(b) Catheter &Y846

Code I(a) using Step 2

Complications (from) (of)

- catheter (device)

- - specified NEC T83.8

Select specified since pulmonary embolism is a specified complication.

Code I(b) Y846 as indexed under Complication, catheter, catheterization (urinary). Precede the E-code with an ampersand.

When the Index does not provide for the term as specified in STEP 1 and STEP 2, code the complication as if procedure NOS was reported instead of the named medical procedure as defined in the following instructions:

NOTE: Before continuing to STEP 3, it is important to determine the nature of the named procedure.

b. When a condition that is

(1) reported due to a named procedure cannot be assigned a code using STEP 1 or STEP 2 or

(2) reported due to a procedure other than surgical operation NOS or therapy NOS, and can be considered as a complication(s) or adverse effect, code as follows:

STEP 3: Determine if the complication is in the Index, qualified:

(a) as reported

(b) with any term meaning “due to” procedure or medical care (see Section II, Part C, 2, a, “Due to” written in or implied)

I (a) Renal failure &N990

(b) Paracentesis Y844

Code I(a) as indexed using Step 3 (c)

Failure

- renal

- - postprocedural N99.0

Code I(b) Y844 as indexed under Complication, paracentesis. Precede N990 with an ampersand.

STEP 4: If the Index does not provide a code for the complication in Steps 1-3, determine if:

(a) the site of the complication is in the Index under Complications (from) (of)

- medical procedure

(b) the system in which the complication occurred (based upon the code assigned in the Index) is in the Index under

Complications (from) (of)

- medical procedure

Complications (from) (of)

- postprocedural

I (a) Cardiac arrest T818

(b) Therapy &Y849

Code I(a) using Step 4 (a)

Complications (from) (of)

- medical procedure

- - cardiac T81.8

Select cardiac since this is the site of the complication.

Code I(b) Y849 as indexed under Complication, procedures other than surgical operation. Precede the E-code and the condition requiring treatment with an ampersand.

I (a) Pulmonary edema &J958

(b) Endotracheal tube Y848

Code I(a) using Step 4 (b)

Complications (from) (of)

- medical procedure

- - respiratory

- - - specified NEC J95.8

Select respiratory, specified since pulmonary edema is classified to J81, a specified disease in the respiratory system.

Code I(b) Y848 as indexed under Complication, procedures other than surgical operation, specified NEC. Precede J958 with an ampersand.

I (a) Stroke I64

(b) Cerebral embolism T817

Code I(b) using Step 4 (b)

Complications (from) (of)

- medical procedure

- - circulatory T81.7

Select circulatory since cerebral embolism is classified to I634, a specified disease in the circulatory system.

Code I(c) Y848 as indexed under Complication, procedures other than surgical operation, specified NEC. Precede the E-code with an ampersand.

STEP 5: When a reported specified complication cannot be classified to a system that is indexed, code T818, Other complications of procedures, not elsewhere classified.

I (a) Shock R579

(b) Coagulation disorder T818

Coagulation disorder is not indexed as due to a procedure or as postprocedural. This condition is classified to D689, a disease of the blood-forming organs. Neither the term nor the body system is indexed under Complications (from) (of), medical procedure.

Code I(b) using Step 5

Complications (from) (of)

- procedure

- - specified T81.8

Select specified since coagulation disorder is a specified complication.

Code I(c) Y848 as indexed under Complication, procedures other than surgical operation, specified NEC. Precede the E-code with an ampersand.

4. Complications of procedures involving administration of drugs, radiation, and instruments

a. Many procedures (e.g., angiogram, barium enema, pyelogram) involve the administration of drugs and the use of x-ray or radioactive substances and various instruments. When complications of these procedures are reported, determine, if possible, which specific part of the procedure caused the complication. Assign the appropriate codes for the complication and the procedure. When the complication is classified to Chapters I-XVIII and the reason for the procedure is not reported, precede the code for the complication with an ampersand. If the reason for the medical care is not reported, do not assume a disease condition.

I (a) Pulmonary embolism T828

(b) Cardiac catheterization &Y840

Code I(a) as the complication of the catheterization. Code I(b) as indexed, Y840 and precede with an ampersand. Code I(c) as indexed and precede with an ampersand to indicate the reason for the procedure.

I (a) Barium impaction of intestine Y575 K564

(b) Barium enema

Code the barium on I(a) to adverse effect in therapeutic use, Y575, since it was the drug that caused the impaction. Code the complication, impaction, as indexed, Impaction, intestine, K564. Do not enter a code on I(b) for barium since it was coded on I(a). Code I(c) as indexed and precede with an ampersand to indicate the reason for the procedure.

I (a) Anaphylactic shock T886

(b) Contrast medium (aortogram) &Y575

II Dissecting aortic arch aneurysm &I710

Code I(a) as the complication of the contrast medium. Indexed as Shock, anaphylactic, correct substance properly administered. Code I(b) contrast medium as adverse effect in therapeutic use, since the drug caused the anaphylactic shock. Code Part II as indexed and precede with an ampersand to indicate the reason for the procedure.

I (a) Peritonitis K659

(b) Hemorrhage of colon K918

(d) Diverticulitis &K579

Code I(a) as indexed. Code I(b) as the complication of the administration of the enema. Code I(c) barium enema, Y848, since the hemorrhage most likely resulted from the administration of the enema rather than the barium. Code I(d) as indexed and precede with an ampersand to indicate the reason for the procedure.

I (a) Cerebral hemorrhage T817

(b) Cerebral arteriogram &Y848

Code I(a) as the complication of the arteriogram. Code I(b) cerebral arteriogram, Y848, since the hemorrhage resulted from the procedure and precede with an ampersand. Do not assume a disease condition for the cerebral arteriogram.

b. When a complication results from the administration of anesthesia, code the complication as indexed and code the appropriate external cause code (Y480-Y485) (refer to Section V, Part R, 1, Drugs, medicaments and biological substances causing adverse effects in therapeutic use).

I (a) Cardiac failure I509

(b) Anesthesia for prostate surgery Y484

Code I(a) as indexed and as the complication of the anesthesia. Code I(b) anesthesia to adverse effect in therapeutic use, Y484, since it was the anesthesia that caused the heart failure. Code I(c) N429, disease prostate, as the reason for surgery and precede with an ampersand.

I (a) Cardiac failure T818

(b) Prostate surgery under anesthesia &Y839

Code I(a) as indexed under Failure, heart, complicating surgery. Code I(b) prostate surgery as indexed. Code I(c) as indexed and precede with an ampersand to indicate the reason for surgery.

5. Complications of radiation during medical care (Y842)

When a complication results from exposure to radiation, except radio-frequency radiation, infrared heaters or lamps and visible or ultraviolet light sources, consider as exposure of patient to radiation during medical care unless there is information on the certificate that indicates otherwise. Code complications of radiation during medical care as follows:

a. Complications qualified as “radiation,” “radiation-induced,” “due to radiation,” or “following radiation”

(1) Coding the complication

(a) If the Index provides a code for the complication qualified by one of these terms, use that code.

(b) If the Index does not provide a code for the complication qualified by one of these terms, code the complication as indexed without the qualifier.

(2) Placement of codes

(a) If the complication is qualified as “radiation” or “radiation-induced” and classified to Chapters I-XVIII, code the external cause code followed by the code for the complication.

(b) If the complication is qualified as “radiation” or “radiation-induced” and classified to Chapter XIX, code the nature of injury code followed by the external cause code.

b. Code the external cause code to Y842, (Radiological procedure and radiotherapy).

c. Use of ampersand

(1) If the reason for the radiation therapy is reported, precede this condition with an ampersand.

(2) If the reason for the radiation therapy is not reported and a malignant neoplasm is reported, precede the neoplasm with an ampersand.

(3) If the reason for the radiation therapy is not reported and the complication is classified to Chapters I-XVIII, precede the complication with an ampersand.

I (a) Pulmonary edema J81

(b) Radiation pneumonitis Y842 J700

(d) &C509

Code I(b) to the external cause as indexed where the radiation is first reported followed by the code for the complication. Pneumonitis is the complication of the radiation and is indexed, Pneumonitis, radiation. Precede the code for cancer of breast with an ampersand to indicate the reason for the radiation.

I (a) Carcinomatosis C80

(b) Oat cell carcinoma &C349

(c)

II X-ray fibrosis - lung Y842 J701

Code Part II to the external cause as indexed followed by the code for the complication. Fibrosis of lung is the complication and is indexed, Fibrosis, lung, following radiation. Code I(b) as indexed and precede with an ampersand to indicate the reason for the radiation.

I (a) Pneumonia J700

(b) Radiation Y842

Pneumonia is the complication of the radiation reported on I(b). Code I(a) as indexed, Pneumonia, radiation. Code the external cause as indexed on I(b). Code I(c) as indexed and precede with an ampersand to indicate the reason for the radiation.

I (a) Debility R53

(b) Radiation therapy Y842

Debility is the complication of the radiation reported on I(b). Code I(a) as indexed since the Classification does not provide a code for radiation debility. Code the external cause as indexed on I(b). Code I(c) as indexed and precede with an ampersand to indicate the reason for the radiation.

I (a) Radiation-induced acute Y842 J700

(b) bronchitis

II Carcinoma of trachea &C33

Code I(a) to the external cause as indexed, followed by the code for the complication. Acute bronchitis is the complication and is indexed Bronchitis, acute, due to radiation. Code Part II as indexed and precede with an ampersand to indicate the reason for the radiation.

I (a) Alopecia L581

(b) Radiation Y842

II Hodgkin granuloma &C817

Alopecia is the complication of the radiation reported on I(b). Code I(a) as indexed under Alopecia, X-ray. Code the external cause as indexed on I(b). Code Part II as indexed and precede with an ampersand to indicate the reason for the radiation.

I (a) Peritonitis K659

(b) Intestinal fistula &K632

Intestinal fistula is the complication of the radiation reported on I(c). Code I(b) as indexed since the Classification does not provide a code for radiation intestinal fistula. Code the external cause as indexed on I(c). Precede the complication (intestinal fistula) with an ampersand since it is classified to Chapters I-XVIII and the reason for the radiation was not reported.

d. When radiation fibrosis is reported without a site or of a site not indexed, code the fibrosis to T66, Complications, radiation.

I (a) Cerebral anoxia G931

(b) Carcinoma of tongue &C029

II Radiation fibrosis, upper airway obstruction T66 &Y842 J988

Code Part II Complications, radiation for the fibrosis and the external cause as indexed. Code the nature of injury followed by the external cause. Place an ampersand preceding the E-code and the condition on I(b) to indicate the reason for the radiation.

I (a) Radiation pelvic fibrosis T66 &Y842

(b) Carcinoma of uterus &C55

Code I(a) Complications, radiation for the pelvic fibrosis and the external cause as indexed. Code the nature of injury followed by the external cause. Place an ampersand preceding the E-code and the condition on I(b) to indicate the reason for the radiation.

6. Misadventures to patients during surgical and medical care (Y60-Y69)

Except for poisoning, overdose of drug and wrong drug given in error, code most misadventures (accidents or errors) to patients during surgical and medical care to Complications of surgical and medical care (T800-T889) in the nature of injury chapter and to Y600-Y69 in the external cause chapter. Code burns from local applications or irradiation to burns in the nature of injury chapter and to Y600-Y69 in the external cause chapter. Code trauma from instruments during delivery to Chapter XV and do not use an external cause. A limited number of conditions attributable to misadventure to patient (Y600-Y69) in the external cause code, e.g., serum hepatitis, are classified to Chapters I-XVIII.

Indications of Misadventures

Hemorrhage (of a site) Stated as intraoperative or

during medical and surgical

Rupture (of a site) care

Cut or cutting (of a site) Reported as postoperative,

Perforation (of a site) intraoperative, during or due

Puncture (of a site) to medical and surgical care

Laceration (of a site)

Burns (of a site) From local applications or

irradiation

Serum hepatitis From blood transfusions

Fracture (thoracic area) From cardiopulmonary resuscitation

From Heimlich maneuver

This list is not all inclusive.

When a misadventure to patient during surgical and medical care (classifiable to Y600-Y69) is reported and the condition which necessitated the surgical or medical care is stated or implied, precede the code for this condition with an ampersand. Apply the instructions for Condition necessitating Surgery in Section V, Part R, 2, b.

I (a) Hemorrhage during T810

(b) craniotomy &Y600

Code I(a) Complication, surgical procedure, hemorrhage. Since “during” is stated, interpret I(b) as a misadventure and code Misadventure, hemorrhage, surgical operation. Code I(c) as indexed and precede with an ampersand to indicate the reason for surgery.

I (a) Perforation of colon T812

(b) Colostomy &Y600 &K639

Code I(a) Perforation, surgical. Interpret I(b) as a misadventure and code Misadventure, perforation, surgical operation. Since the surgery indicates a disease of the colon, code this as the reason for surgery. Precede K639 with an ampersand

I (a) Cardiac tamponade I319

(b) Perforation of auricle by cardiac catheter T812 &Y605

II Therapeutic misadventure T889

The perforation occurred during a cardiac catheterization. Code I(b) as accidental perforation of organ during a procedure, and accidental perforation during a heart catheterization. Code Part II as indexed, Misadventure (prophylactic) (therapeutic).

I (a) Peritonitis K659

(b) Accidental perforation of T812 &Y607

II Self-administered tap water enema

I(b) is a reported misadventure occurring during medical care. Code T812, accidental perforation during a procedure and Y607, accidental perforation during the administration of an enema.

I (a) Serum hepatitis B169

(b) Blood transfusion Y640

Serum hepatitis is a misadventure occurring during a blood transfusion. Code I(a) B169, serum hepatitis, and I(b) Y640, Contaminated medical or biological substance transfused or infused. Code I(c) as indexed and precede with an ampersand to indicate the reason for the transfusion.

I (a) Burns T300

(b) Radiation therapy &Y632

Code I(a) T300, radiation burns. Code I(b) Y632, Overdose of radiation given during therapy. Code I(c) as indexed and precede with an ampersand to indicate the reason for the radiation.

I (a) Rib fracture T818

(b) Cardiopulmonary resuscitation &Y658

Rib fracture due to cardiopulmonary resuscitation is considered a misadventure. Code I(a) Complications, medical procedure, specified NEC T818. Code I(b) Misadventure, specified type Y658. Code I(c) as indexed and precede with an ampersand to indicate the reason for cardiopulmonary resuscitation.

I (a) HIV B24

(b) Blood transfusion

Code I(a) and I(c) as indexed. No code for I(b) since there are no complications reported. Do not consider HIV (any B20-B24) as a misadventure occurring during a blood transfusion.

S. Sequela of injuries, poisonings, and other consequences of external causes

A sequela is a late effect, an after effect, or a residual of a nature of injury or external cause. The Classification provides categories T900-T983 for sequela of nature of injury codes and Y850-Y899 for sequela of external causes. There are separate instructions for determining if the nature of injury or the external cause should be coded as sequela. If either the nature of injury or the external cause requires a sequela code, both the nature of injury and the external cause must be coded to a sequela category.

1. Sequela of injuries, poisoning, and other consequences of external causes (T900-T983)

Use these categories for the classification of injuries and poisonings (conditions in S00-T88) if:

a. A statement of sequela of the condition in S00-T88 is reported unless the interval between date of injury and date of death is less than 1 year.

I (a) Sequela of hip fracture T931

(b)

(c)

II &Y86

Code I(a) to T931 since it is stated as a sequela of hip fracture. Code Part II as sequela of accident NEC.

b. The condition in S00-T88 is stated to be ancient, by history, healed, history, history of, late effect of, old, remote, regardless of reported duration, or the interval between onset of this condition and death is indicated to be 1 year or more, whether or not the residual (sequela) effect is specified.

Date of death 12/1/98

I (a) Old head injury T909

MOD II &Y86

Accident

Farm

Date of injury 9/3/98

Tractor overturned

Code I(a) old head injury to Sequela, injury, head since it is stated as old. Interpret “tractor overturning on farm” as contact with agricultural machinery. Code Part II accident - tractor overturned to sequela of other accidents since it resulted in an injury stated as old.

c. A condition with a duration of 1 year or more that was due to the condition in S00-T88 is reported.

I (a) Paralysis 16 mos. T941

(b) Spinal cord injury T913

Code I(a) paralysis to sequela of traumatic paralysis since it is reported due to trauma and has a duration of 1 year or more. Code I(b) spinal cord injury to Sequela, injury, spinal, cord since it caused a condition of 1 year or more. Code I(c) auto accident, to Sequela, motor vehicle accident.

d. More than one nature of injury or a nature of injury and an external cause are reported on the same line with a duration of 1 year or more, apply the duration to each condition.

I (a) Head injury and skull fracture Years T909 T902

(b)

II Fall &Y86

Code both conditions on I(a) as sequela. Do not disregard the duration since there is more than one injury on same line.

I (a) Gunshot wound head Years T901 &Y86

Code both head wound and gunshot as sequela. Apply duration to nature of injury and external cause.

2. Sequela of external causes (Y850-Y899)

Y850 Sequela of motor vehicle accident (includes V01-V89)

Y859 Sequela of other and unspecified transport accidents (includes V90-V99)

Y86 Sequela of other accidents (excludes W78-W80)

Y870 Sequela of intentional self-harm

Y871 Sequela of assault

Y872 Sequela of events of undetermined intent

Y880 Sequela of adverse effects caused by drugs, medicaments, and biological substances in therapeutic use

Y881 Sequela of misadventures to patients during surgical and medical procedures

Y882 Sequela of adverse incidents associated with medical devices in diagnostic and therapeutic use

Y883 Sequela of surgical and medical procedures as the cause of abnormal reaction of the patient, or of later complication, without

mention of misadventure at the time of the procedure

Y890 Sequela of legal intervention

Y891 Sequela of war operations

Y899 Sequela of unspecified external cause

Use the preceding categories with the appropriate fourth characters for the classification of external causes of injury (V010-Y849) if:

a. A statement of sequela of the external cause is reported unless the interval between date of external cause and date of death is less than 1 year.

I (a) Paralysis, sequela of T941 &Y86

(b) fall down steps

Code I(a) to sequela of traumatic paralysis and sequela of fall down the steps.

b. An injury that is stated to be ancient, by history, healed, history, history of, late effect of, old, remote, or a delayed union that was due to the external cause is reported.

I (a) Pneumonia J189

MOD (b) Debility R53

A (c) Nonunion of hip fracture M841

II Inanition R64 Y86

Accident

Fell at home

Code I(c) as indexed. Code sequela of fall last in Part II since the fall resulted in nonunion of the fracture.

I (a) ASHD I251

II Old fractured hip T931 &Y86

Code I(a) ASHD as indexed. Code Part II old fractured hip, T931 Y86, since the injury was specified as old.

c. If the external cause is stated to be ancient, by history, history, history of, old, remote, regardless of reported duration, or the interval between onset of the external cause and death is indicated to be 1 year or more.

I (a) Old fall, fractured hip 6 months T931 &Y86

(b)

(c)

MOD II T931

Accident

Fell and fractured hip 6 months ago

Code as sequela since the external cause is stated as “old.”

d. A condition with a duration of 1 year or more that was due to the external cause is reported.

I (a) Subdural hematoma 1 year T905

(b) Fall &Y86

Code I(a) subdural hematoma, T905, since it is reported to be of 1 year or more duration. Code I(b) fall, Y86, since it resulted in a condition of 1 year or more duration.

I (a) Esophageal stricture years K222

(b) Ingestion of lye T97 &Y870

II Suicide attempt

Code I(a) esophageal stricture as indexed. Code I(b) ingestion of lye, T97 Y870, since it resulted in a condition of 1 year or more duration.

e. The interval between the time of occurrence of the external cause and death is indicated to be 1 year or more, whether or not the residual (sequela) effect is specified.

Date of death 11/1/96

I (a) Bronchopneumonia J180

MOD II Contusion brain T905 &Y850

Accident

Street

Date of injury 5/20/95

Bicycle (operator) vs. truck

Code I(a) bronchopneumonia as indexed. Code sequela of nature of injury and external cause since the date of injury is 1 year or more prior to death.

I (a) Cardiac arrest I469

(b) Pacemaker failure weeks T983 &Y883 &I519

Code I(a) cardiac arrest as indexed. Code I(b) pacemaker failure to sequela T983 and Y883 since duration of implanted pacemaker is 3 years. Code I519, Disease, heart since pacemaker indicates a heart disease. Precede I519 with an ampersand as reason for the surgery. Do not enter a code on I(c).

f. The complication of the external cause classified to Chapters I-XVIII and the external cause is reported on the same line and the duration is 1 year or more.

I (a) Radiation enteritis 3 years Y883 K520

(b) Lung cancer &C349

Code I(a) as a sequela of radiation therapy. Do not disregard the duration. Precede the code for the lung cancer with an ampersand to indicate the reason for medical care.

APPENDIX A - STANDARD ABBREVIATIONS AND SYMBOLS

When an abbreviation is reported on the certificate, refer to this list to determine what the abbreviation represents. If an abbreviation represents more than one term, determine the correct abbreviation by using other information on the certificate. If no determination can be made, use abbreviation for first term listed.

A2GDM class A2 gestational diabetes mellitus

AAA abdominal aortic aneurysm

AAS aortic arch syndrome

AAT alpha-antitrypsin

AAV AIDS-associated virus

AB abdomen; abortion; asthmatic bronchitis

ABD abdomen

ABE acute bacterial endocarditis

ABS acute brain syndrome

ACA adenocarcinoma

ACD arteriosclerotic coronary disease

ACH adrenal cortical hormone

ACT acute coronary thrombosis

ACTH adrenocorticotrophic hormone

ACVD arteriosclerotic cardiovascular disease

ADEM acute disseminated encephalomyelitis

ADH antidiuretic hormone

ADS antibody deficiency syndrome

AEG air encephalogram

AF auricular or atrial fibrillation; acid fast

AFB acid-fast bacillus

AGG agammaglobulinemia

AGL acute granulocytic leukemia

AGN acute glomerulonephritis

AGS adrenogenital syndrome

AHA acquired hemolytic anemia; autoimmune hemolytic anemia

AHD arteriosclerotic heart disease

AHHD arteriosclerotic hypertensive heart disease

AHG anti-hemophilic globulin deficiency

AHLE acute hemorrhagic leukoencephalitis

AI aortic insufficiency; additional information

AIDS acquired immunodeficiency syndrome

AKA above knee amputation

AKI acute kidney injury

ALC alcoholism

ALL acute lymphocytic leukemia

ALS amyotrophic lateral sclerosis

AMA advanced maternal age; against medical advice; antimitochondrial antibody(ies)

AMI acute myocardial infarction

AML acute myelocytic leukemia

ANS arteriolonephrosclerosis

AOD arterial occlusive disease

AODM adult onset diabetes mellitus

AOM acute otitis media

AP angina pectoris; anterior and posterior repair; artificial pneumothorax; anterior pituitary

A&P anterior and posterior repair

APC auricular premature contraction; acetylsalicylic acid, acetophenetidin, and caffeine

APE acute pulmonary edema; anterior pituitary extract

APH antepartum hemorrhage

AR aortic regurgitation

ARC AIDS-related complex

ARDS adult respiratory distress syndrome

ARF acute respiratory failure; acute renal failure

ARM artificial rupture of membranes

ARV AIDS-related virus

ARVD arrhythmogenic right ventricular dysplasia

AS arteriosclerotic; arteriosclerosis; aortic stenosis

ASA acetylsalicylic acid (aspirin)

ASAD arteriosclerotic artery disease

ASCAD arteriosclerotic coronary artery disease

ASCD arteriosclerotic coronary disease

ASCHD arteriosclerotic coronary heart disease

ASCRD arteriosclerotic cardiorenal disease

ASCVA arteriosclerotic cerebrovascular accident

ASCVD arteriosclerotic cardiovascular disease

ASCVR arteriosclerotic cardiovascular renal disease

ASCVRD arteriosclerotic cardiovascular renal disease

ASD atrial septal defect

ASDHD arteriosclerotic decompensated heart disease

ASHCVD arteriosclerotic hypertensive cardiovascular disease

ASHD arteriosclerotic heart disease; atrioseptal heart defect

ASHHD arteriosclerotic hypertensive heart disease

ASHVD arteriosclerotic hypertensive vascular disease

ASO arteriosclerosis obliterans

ASPVD arteriosclerotic peripheral vascular disease

ASVD arteriosclerotic vascular disease

ASVH(D) arteriosclerotic vascular heart disease

AT atherosclerosis; atherosclerotic; atrial tachycardia; antithrombin

ATC all-terrain cycle

ATN acute tubular necrosis

ATS arteriosclerosis

ATSHD arteriosclerotic heart disease

ATV all-terrain vehicle

AUL acute undifferentiated leukemia

AV arteriovenous; atrioventricular; aortic valve

AVF arterio-ventricular fibrillation; arteriovenous fistula

AVH acute viral hepatitis

AVNRT atrioventricular nodal re-entrant tachycardia

AVP aortic valve prosthesis

AVR aortic valve replacement

AVRT atrioventricular nodal re-entrant tachycardia

AWMI anterior wall myocardial infarction

AZT azidothymidine

BA basilar artery; basilar arteriogram; bronchial asthma

B&B bronchoscopy and biopsy

BBB bundle branch block

B&C biopsy and cauterization

BCE basal cell epithelioma

BE barium enema

BEH benign essential hypertension

BGL Bartholin gland

BKA below knee amputation

BL bladder; bucolingual; blood loss; Burkitt lymphoma

BMR basal metabolism rate

BNA bladder neck adhesions

BNO bladder neck obstruction

BOMSA bilateral otitis media serous acute

BOMSC bilateral otitis media serous chronic

BOW 'bag of water' (membrane)

B/P, BP blood pressure

BPH benign prostate hypertrophy

BSA body surface area

BSO bilateral salpingo-oophorectomy

BSP Bromosulfaphthalein (test)

BTL bilateral tubal ligation

BUN blood, urea, and nitrogen test

BVL bilateral vas ligation

B&W Baldy-Webster suspension (uterine)

BX biopsy

BX CX biopsy cervix

Ca cancer

CA cancer; cardiac arrest; carotid arteriogram

CABG coronary artery bypass graft

CABS coronary artery bypass surgery

CAD coronary artery disease

CAG chronic atrophic gastritis

CAO coronary artery occlusion; chronic airway obstruction

CAR cardiac arrest

CAS cerebral arteriosclerosis

CASCVD chronic arteriosclerotic cardiovascular disease

CASHD chronic arteriosclerotic heart disease

CAT computerized axial tomography

CB chronic bronchitis

CBC complete blood count

CBD common bile duct; chronic brain disease

CBS chronic brain syndrome

CCF chronic congestive failure

CCI chronic cardiac or coronary insufficiency

CF congestive failure; cystic fibrosis; Christmas factor (PTC)

CFT chronic follicular tonsillitis

CGL chronic granulocytic leukemia

CGN chronic glomerulonephritis

CHA congenital hypoplastic anemia

CHB complete heart block

CHD congestive heart disease; coronary heart disease; congenital heart disease; Chediak-Higaski Disease

CHF congestive heart failure

C2H5OH ethyl alcohol

CI cardiac insufficiency; cerebral infarction

CID cytomegalic inclusiondisease

CIS carcinoma in situ

CJD Creutzfeldt-Jakob Disease

CLD chronic lung disease; chronic liver disease

CLL chronic lymphatic leukemia; chronic lymphocytic leukemia

CMID cytomegalic inclusion disease

CML chronic myelocytic leukemia

CMM cutaneous malignant melanoma

CMV cytomegalic virus

CNHD congenital nonspherocytic hemolytic disease

CNS central nervous system

CO carbon monoxide

COAD chronic obstructive airway disease

CO2 carbon dioxide

COBE chronic obstructive bullous emphysema

COBS chronic organic brain syndrome

COFS cerebro-oculo-facio-skeletal

COOMBS test for Rh sensitivity

COLD chronic obstructive lung disease

COPD chronic obstructive pulmonary disease

COPE chronic obstructive pulmonary emphysema

CP cerebral palsy; cor pulmonale

C&P cystoscopy and pyelography

CPB cardiopulmonary bypass

CPC chronic passive congestion

CPD cephalopelvic disproportion; contagious pustular dermatitis

CPE chronic pulmonary emphysema

CRD chronic renal disease

CREST calcinosis cutis, Raynaud phenomenon, sclerodactyly, and telangiectasis

CRF cardiorespiratory failure; chronic renal failure

CRST calcinosis cutis, Raynaud phenomenon, sclerodactyly, and telangiectasis

CS coronary sclerosis; cesarean section; cerebro-spinal

CSF cerebral spinal fluid

CSH chronic subdural hematoma

CSM cerebrospinal meningitis

CT computer tomography; cerebral thrombosis; coronary thrombosis

CTD congenital thymic dysplasia

CU cause unknown

CUC chronic ulcerative colitis

CUP cystoscopy, urogram, pyelogram (retro)

CUR cystocele, urethrocele, rectocele

CV cardiovascular; cerebrovascular

CVA cerebrovascular accident

CV accident cerebral vascular accident

CVD cardiovascular disease

CVHD cardiovascular heart disease

CVI cardiovascular insufficiency; cerebrovascular insufficiency

CVID common variable immunodeficiency

CVRD cardiovascular renal disease

CWP coalworker pneumoconiosis

CX cervix

DA degenerative arthritis

DBI phenformin hydrochloride

D&C dilation and curettage

DCR dacrocystorhinostomy

D&D drilling and drainage; debridement and dressing

D&E dilation and evacuation

DFU dead fetus in utero

DIC disseminated intravascular coagulation

DILD diffuse infiltrative lung disease

DIP distal interphalangeal joint; desquamative interstitial pneumonia

DJD degenerative joint disease

DM diabetes mellitus

DMT dimethyltriptamine

DOA dead on arrival

DOPS diffuse obstructive pulmonary syndrome

DPT diphtheria, pertussis, tetanus vaccine

DR diabetic retinopathy

DS Down syndrome

DT due to; delirium tremens

D/T due to; delirium tremens

DU diagnosis unknown; duodenal ulcer

DUB dysfunctional uterine bleeding

DUI driving under influence

DVT deep vein thrombosis

DWI driving while intoxicated

DX dislocation; diagnosis; disease

EBV Epstein-Barr virus

ECCE extracapsular cataract extraction

ECG electrocardiogram

E coli Escherichia coli

ECT electric convulsive therapy

EDC expected date of confinement

EEE Eastern equine encephalitis

EEG electroencephalogram

EFE endocardial fibroelastosis

EGL eosinophilic granuloma of lung

EH enlarged heart; essential hypertension

EIOA excessive intake of alcohol

EKC epidemic keratoconjunctivitis

EKG electrocardiogram

EKP epikeratoprosthesis

ELF elective low forceps

EMC encephalomyocarditis

EMD electromechanical dissociation

EMF endomyocardial fibrosis

EMG electromyogram

EN erythema nodosum

ENT ear, nose, and throat

EP ectopic pregnancy

ER emergency room

ERS evacuation of retained secundines

ESRD end-stage renal disease

EST electric shock therapy

ETOH ethyl alcohol

EUA exam under anesthesia

EWB estrogen withdrawal bleeding

FB foreign body

FBS fasting blood sugar

Fe symbol for iron

FGD fatal granulomatous disease

FHS fetal heart sounds

FHT fetal heart tone

FLSA follicular lymphosarcoma

FME full-mouth extraction

FS frozen section; fracture site

FT full term

FTA fluorescent treponemal antibody test

FTD fronto-temporal dementia

5FU fluorouracil

FUB functional uterine bleeding

FULG fulguration

FUO fever unknown origin

FX fracture

FYI for your information

GAS generalized arteriosclerosis

GB gallbladder; Guillain-Barre (syndrome)

GC gonococcus; gonorrhea; general circulation (systemic)

GE gastroesophageal

GEN generalized

GERD gastroesophageal reflux disease

GI gastrointestinal

GIB gastrointestinal bleeding

GIST gastrointestinal stromal tumor

GIT gastrointestinal tract

GMSD grand mal seizure disorder

GOK God only knows

GSW gunshot wound

GTT glucose tolerance test

Gtt drop

GU genitourinary; gastric ulcer

GVHR graft-versus-host reaction

GYN gynecology

HA headache

HAA hepatitis-associated antigen

HASCVD hypertensive arteriosclerotic cardiovascular disease

HASCVR hypertensive arteriosclerotic cardiovascular renal disease

HASHD hypertensive arteriosclerotic heart disease

HBP high blood pressure

HC Huntington chorea

HCAP health care associated pneumonia

HCPS Hantivirus (cardio) pulmonary syndrome, Hantavirus cardiopulmonary syndrome

HCT hematocrit

HCVD hypertensive cardiovascular disease

HCVRD hypertensive cardiovascular renal disease

HD Hodgkin disease; heart disease

HDN hemolytic disease of newborn

HDS herniated disc syndrome

HEM hemorrhage

HF heart failure; hay fever

HGB; Hgb hemoglobin

HHD hypertensive heart disease

HIV human immunodeficiency virus

HMD hyaline membrane disease

HN2 nitrogen mustard

HNP herniated nucleus pulposus

H/O history of

HPN hypertension

HPS Hantavirus pulmonary syndrome

HPVD hypertensive pulmonary vascular disease

HRE high-resolution electrocardiology

HS herpes simplex; Hurler syndrome

HSV herpes simplex virus

HTLV human T-cell lymphotropic virus

HTLV human T-cell lymphotropic

III/LAV virus-III/lymphadenopathy- associated virus

HTLV-3 human T-cell lymphotropic virus-III

HTLV-III human T-cell lymphotropic virus-III

HTN hypertension

HVD hypertensive vascular disease

Hx history of

IADH inappropriate antidiuretic hormone

IASD interatrial septal defect

ICCE intracapsular cataract extraction

ICD intrauterine contraceptive device

I&D incision and drainage

ID incision and drainage

IDA iron deficiency anemia

IDD insulin-dependent diabetes

IDDI insulin-dependent diabetes

IDDM insulin-dependent diabetes mellitus

IGA immunoglobin A

IHD ischemic heart disease

IHSS idiopathic hypertrophic subaortic stenosis

IIAC idiopathic infantile arterial calcification

ILD interstitial lung disease; ischemic leg disease

IM intramuscular; intramedullary; infectious mononucleosis

IMPP intermittent positive pressure

INAD infantile neuroaxonal dystrophy

INC incomplete

INE infantile necrotizing encephalomyelopathy

INF infection; infected; infantile; infarction

INH isoniazid; inhalation

INS idiopathic nephrotic syndrome

IRDM insulin resistant diabetes mellitus

IRHD inactive rheumatic heart disease

IRIS immune reconstitution inflammatory syndrome

ISD interatrial septal defect

ITP idiopathic thrombocytopenic purpura

IU intrauterine

IUCD intrauterine contraceptive device

IUD intrauterine device (contraceptive); intrauterine death

IUP intrauterine pregnancy

IV intervenous; intravenous

IVC intravenous cholangiography; inferior vena cava

IVCC intravascular consumption coagulopathy

IVD intervertebral disc

IVH intraventricular hemorrhage

IVP intravenous pyelogram

IVSD intraventricular septal defect

IVU intravenous urethrography

IWMI inferior wall myocardial infarction

JAA juxtaposition of atrial appendage

JBE Japanese B encephalitis

KFS Klippel-Feil syndrome

KS Klinefelter syndrome

KUB kidney, ureter, bladder

K-W Kimmelstiel-Wilson disease or syndrome

LAP laparotomy

LAV lymphadenopathy-associated virus

LAV/HTLV-III lymphadenopathy-associated virus/human T-cell lymphotrophic virus-III

LBBB left bundle branch block

LBNA lysis bladder neck adhesions

LBW low birth weight

LBWI low birth weight infant

LCA left coronary artery

LDH lactic dehydrogenase

LE lupus erythematosus; lower extremity; left eye

LKS liver, kidney, spleen

LL lower lobe

LLL left lower lobe

LLQ lower left quadrant

LMA left mentoanterior (position of fetus)

LML left middle lobe; left mesiolateral

LMCAT left middle cerebral artery thrombosis

LML left mesiolateral; left mediolateral (episiotomy)

LMP last menstrual period; left mento-posterior (position of fetus)

LN lupus nephritis

LOA left occipitoanterior

LOMCS left otitis media chronic serous

LP lumbar puncture

LRI lower respiratory infection

LS lumbosacral; lymphosarcoma

LSD lysergic acid diethylamide

LSK liver, spleen, kidney

LUL left upper lobe

LUQ left upper quadrant

LV left ventricle

LVF left ventricular failure

LVH left ventricular hypertrophy

MAC mycobacterium avium complex

MAI mycobacterium avium intracellulare

MAL malignant

MBAI mycobacterium avium intracellulare

MBD minimal brain damage

MCA metastatic cancer; middle cerebral artery

MD muscular dystrophy; manic depressive; myocardial damage

MDA methylene dioxyamphetamine

MEA multiple endocrine adenomatosis

MF myocardial failure; myocardial fibrosis; mycosis fungoides

MGN membranous glomerulonephritis

MHN massive hepatic necrosis

MI myocardial infarction; mitral insufficiency

MPC meperidine, promethazine, chlorpromazine

MRS methicillin resistant staphylococcal

MRSA methicillin resistant staphylococcal aureus

MRSAU methicillin resistant staphylococcal aureus

MS multiple sclerosis; mitral stenosis

MSOF multi-system organ failure

MT malignant teratoma

MUA myelogram

MVP mitral valve prolapse

MVR mitral valve regurgitation; mitral valve replacement

NACD no anatomical cause of death

NAFLD nonalcoholic fatty liver disease

NCA neurocirculatory asthenia

NDI nephrogenic diabetes insipidus

NEG negative

NFI no further information

NFTD normal full-term delivery

NG nasogastric

NH3 symbol for ammonia

NIDD non-insulin-dependent diabetes

NIDDI non-insulin-dependent diabetes

NIDDM non-insulin-dependent diabetes mellitus

NSTEMI non-ST-elevation myocardial infarction

N&V nausea and vomiting

NVD nausea, vomiting, diarrhea

OA osteoarthritis

OAD obstructive airway disease

OB obstetrical

OBS organic brain syndrome

OBST obstructive; obstetrical

OD overdose; oculus dexter (right eye); occupational disease

OHD organic heart disease

OLT orthotopic liver transplant

OM otitis media

OMI old myocardial infarction

OMS organic mental syndrome

OPCA olivopontocerebellar atrophy

ORIF open reduction, internal fixation

OS oculus sinister (left eye); occipitosacral (fetal position)

OT occupational therapy; old TB

OU oculus uterque (each eye); both eyes

PA pernicious anemia; paralysis agitans; pulmonary artery; peripheral arteriosclerosis

PAC premature auricular contraction; phenacetin, aspirin, caffeine

PAD peripheral artery disease

PAF paroxysmal auricular fibrillation

PAOD peripheral arterial occlusive disease; peripheral arteriosclerosis occlusive disease

PAP primary atypical pneumonia

PAS pulmonary artery stenosis

PAT pregnancy at term; paroxysmal auricular tachycardia

Pb chemical symbol for lead

PCD polycystic disease

PCF passive congestive failure

PCP pentachlorophenol; pneumocystis carinii pneumonia

PCT porphyria cutanea tarda

PCV polycythemia vera

PDA patent ductus arteriosus

PE pulmonary embolism; pleural effusion; pulmonary edema

PEG percutaneous endoscopic gastrostomy; pneumoencephalography

PEGT percutaneous endoscopic gastrostomy tube

PET pre-eclamptic toxemia

PG pregnant; prostaglandin

PGH pituitary growth hormone

PH past history; prostatic hypertrophy; pulmonary hypertension

PI pulmonary infarction

PID pelvic inflammatory disease; prolapsed intervertebral disc

PIE pulmonary interstitial emphysema

PIP proximal interphalangeal joint

PKU phenylketonuria

PMD progressive muscular dystrophy

PMI posterior myocardial infarction; point of maximum impulse

PML progressive multifocal leukoencephalopathy

PN pneumonia; periarteritis nodosa; pyelonephritis

PO postoperative; by mouth

POC product of conception

POE point (or portal) of entry

POSS possible; possibly

PP postpartum

PPD purified protein derivative test for tuberculosis

PPH postpartum hemorrhage

PPLO pleuropneumonia-like organism

PPS postpump syndrome

PPT precipitated; prolonged prothrombin time

PREM prematurity

PROB probably

PPROM preterm premature rupture of membranes

PROM premature rupture of membranes

PSVT paroxysmal supraventricular tachycardia

PT paroxysmal tachycardia; pneumothorax; prothrombin time

PTA persistent truncus arteriosus

PTC plasma thromboplastin component

PTCA percutaneous transluminal coronary angioplasty

PTLA percutaneous transluminal laser angioplasty

PU peptic ulcer

PUD peptic ulcer disease; pulmonary disease

PUO pyrexia of unknown origin

P&V pyloroplasty and vagotomy

PVC premature ventricular contraction

PVD peripheral vascular disease; pulmonary vascular disease

PVI peripheral vascular insufficiency

PVL periventricular leukomalacia

PVT paroxysmal ventricular tachycardia

PVS premature ventricular systole (contraction)

PWI posterior wall infarction

PWMI posterior wall myocardial infarction

PX pneumothorax

R right

RA rheumatoid arthritis; right atrium; right auricle

RAAA ruptured abdominal aortic aneurysm

RAD rheumatoid arthritis disease; radiation absorbed dose

RAI radioactive iodine

RBBB right bundle branch block

RBC red blood cells

RCA right coronary artery

RCS reticulum cell sarcoma

RD Raynaud disease; respiratory disease

RDS respiratory distress syndrome

RE regional enteritis

REG radioencephalogram

RESP respiratory

RHD rheumatic heart disease

RLF retrolental fibroplasia

RLL right lower lobe

RLQ right lower quadrant

RMCA right middle cerebral artery

RMCAT right middle cerebral artery thrombosis

RML right middle lobe

RMLE right mediolateral episiotomy

RNA ribonucleic acid

RND radical neck dissection

R/O rule out

RSA reticulum cell sarcoma

RSR regular sinus rhythm

Rt right

RT recreational therapy; right

RTA renal tubular acidosis

RUL right upper lobe

RUQ right upper quadrant

RV right ventricle

RVH right ventricular hypertrophy

RVT renal vein thrombosis

RX drugs or other therapy or treatment

SA sarcoma; secondary anemia

SACD subacute combined degeneration

SARS severe acute respiratory syndrome

SBE subacute bacterial endocarditis

SBO small bowel obstruction

SBP spontaneous bacterial peritonitis

SC sickle cell

SCC squamous cell carcinoma

SCI subcoma insulin; spinal cord injury

SD spontaneous delivery; septal defect; sudden death

SDAT senile dementia Alzheimer type

SDII sudden death in infancy

SDS sudden death syndrome

SEPT septicemia

SF scarlet fever

SGA small for gestational age

SH serum hepatitis

SI saline injection

SIADH syndrome of inappropriate antidiuretic hormone

SICD sudden infant crib death

SID sudden infant death

SIDS sudden infant death syndrome

SIRS systemic inflammatory response syndrome

SLC short leg cast

SLE systemic lupus erythematosus; Saint Louis encephalitis

SMR submucous resection

SNB scalene node biopsy

SO or S&O salpingo-oophorectomy

SOB shortness of breath

SOM secretory otitis media

SOR suppurative otitis, recurrent

S/P status post

SPD sociopathic personality disturbance

SPP suprapubic prostatectomy

SQ subcutaneous

S/R schizophrenic reaction; sinus rhythm

S/p P/T schizophrenic reaction, paranoid type

SSE soapsuds enema

SSKI saturated solution potassium iodide

SSPE subacute sclerosing panencephalitis

STAPH staphylococcal; staphylococcus

STB stillborn

STREP streptococcal; streptococcus

STS serological test for syphilis

STSG split thickness skin graft

SUBQ subcutaneous

SUD sudden unexpected death

SUDI sudden unexplained death of an infant

SUID sudden unexpected infant death

SUPC sudden unexpected postnatal collapse

SVC superior vena cava

SVD spontaneous vaginal delivery

SVT superventricular tachycardia

Sx symptoms

SY syndrome

T&A tonsillectomy and adenoidectomy

TAH total abdominal hysterectomy

TAL tendon achilles lengthening

TAO triacetyloleandomycin (antibiotic); thromboangiitis obliterans

TAPVR total anomalous pulmonary venous return

TAR thrombocytopenia absent radius (syndrome)

TAT tetanus anti-toxin

TB tuberculosis; tracheobronchitis

TBC, Tbc tuberculosis

TCI transient cerebral ischemia

TEF tracheoesophageal fistula

TF tetralogy of Fallot

TGV transposition great vessels

THA total hip arthroplasty

TI tricuspid insufficiency

TIA transient ischemic attack

TIE transient ischemic episode

TL tubal ligation

TM tympanic membrane

TOA tubo-ovarian abscess

TP thrombocytopenic purpura

TR tricuspid regurgitation, transfusion reaction

TSD Tay-Sachs disease

TTP thrombotic thrombocytopenic purpura

TUI transurethral incision

TUR transurethral resection (NOS) (prostate)

TURP transurethral resection of prostate

TVP total anomalous venous return

UC ulcerative colitis

UGI upper gastrointestinal

UL upper lobe

UNK unknown

UP ureteropelvic

UPJ ureteropelvic junction

URI upper respiratory infection

UTI urinary tract infection

VAMP vincristine, amethopterine, 6-mercaptopurine, and prednisone

VB vinblastine

VC vincristine

VD venereal disease

VDRL venereal disease research lab

VEE Venezuelan equine encephalomyelitis

VF ventricular fibrillation

VH vaginal hysterectomy; viral hepatitis

VL vas ligation

VM viomycin

V&P vagotomy and pyloroplasty

VPC, VPCS ventricular premature contractions

VR valve replacement

VSD ventricular septal defect

VT ventricular tachycardia

WBC white blood cell

WC whooping cough

WE Western encephalomyelitis

W/O without

WPW Wolfe-Parkinson-White syndrome

YF yellow fever

ZE Zollinger-Ellison (syndrome)

' minute

" second(s)

< less than

> greater than

⬇ decreased

⬆ increased; elevated

c with

s without

00 secondary to

11 to

99 means unknown when reported in duration block, such as "99 years" = unknown duration

APPENDIX B - SYNONYMOUS SITES/TERMS

When a condition of a stated anatomical site is indexed in Volume 3, code condition of stated site as indexed. If stated site is not indexed, code condition of synonymous site.

Alimentary canal Gastrointestinal tract

Body Torso, trunk

Brain Anterior fossa, basal ganglion, central nervous

system, cerebral, cerebrum, frontal, occipital,

parietal, pons, posterior fossa, prefrontal, temporal,

III and IV ventricle

NOTE: Do not use brain when ICD provides for CNS

under the reported condition.

Cardiac Heart

Chest Thorax

Geriatric Senile

Greater sac Peritoneum

Hepatic Liver

Hepatocellular Liver

Intestine Bowel, colon

Kidney Renal

Larynx Epiglottis, subglottis, supraglottis, vocal cords

Lesser sac Peritoneum

Nasopharynx, pharynx Throat

Pulmonary Lung

Right\left hemispheric Code brain

Hemispheric NOS Do not assume brain

Right\left ventricle Heart

Third\fourth ventricle Brain

LLL, LUL, RLL, RML, RUL Lobes of the lungs when reported with lobectomy,

pneumonia, etc.

APPENDIX C - GEOGRAPHIC CODES

Alabama AL

Alaska AK

Arizona AZ

Arkansas AR

California CA

Colorado CO

Connecticut CT

Delaware DE

District of Columbia DC

Florida FL

Georgia GA

Hawaii HI

Idaho ID

Illinois IL

Indiana IN

Iowa IA

Kansas KS

Kentucky KY

Louisiana LA

Maine ME

Maryland MD

Massachusetts MA

Michigan MI

Minnesota MN

Mississippi MS

Missouri MO

Montana MT

Nebraska NE

Nevada NV

New Hampshire NH

New Jersey NJ

New Mexico NM

New York NY

North Carolina NC

North Dakota ND

Ohio OH

Oklahoma OK

Oregon OR

Pennsylvania PA

Puerto Rico PR

Rhode Island RI

South Carolina SC

South Dakota SD

Tennessee TN

Texas TX

Utah UT

Vermont VT

Virginia VA

Virgin Islands VI

Washington WA

West Virginia WV

Wisconsin WI

Wyoming WY

Territories and Outlying Areas

American Samoa AS

Federated States of Micronesia FM

Guam GU

Marshall Islands MH

Northern Mariana Islands MP

Palau PW

Puerto Rico PR

Virgin Islands (US) VI

US Minor Outlying Islands UM*

Baker Island

Howland Island

Jarvis Island

Johnston Atoll

Kingman Reef

Midway Islands

Navassa Island

Palmyra Atoll

Wake Island

APPENDIX D - CODE FOR PLACE OF OCCURRENCE

0. Home

Excludes: Abandoned or derelict house (8)
Home under construction, but not yet occupied (6)
Institutional place of residence (1)
Office in home (5)

About home

Apartment

Bed and breakfast

Boarding house

Cabin (any type)

Caravan (trailer) park - residential

Condominium

Farm house

Dwelling

Hogan

Home premises

Home sidewalk

Home swimming pool

House (residential) (trailer)

Noninstitutional place of residence

Penthouse

Private driveway to home

Private garage

Private garden to home

Private walk to home

Private wall to home

Residence

Rooming house

Storage building at apartment

Swimming pool in private home, private garden, apartment or residence

Townhome

Trailer camp or court

Yard (any part) (area) (front) (residential)

Yard to home

1. Residential institution

Almshouse

Army camp

Assisted Living

Board and care facility

Children’s home

Convalescent home

Correctional center

Detox center

Dormitory

Fraternity house

Geriatric center

Halfway house

Home for the sick

Hospice

Institution (any type)

Jail

Mental Hospital

Military (camp) (reservation)

Nurse’s home

Nursing home

Old people’s home

Orphanage

Penitentiary

Pensioner’s home

Prison

Prison camp

Reform school

Retirement home

Sorority house

State hospital

2. School, other institution and public administrative area

Excludes: Building under construction (6)
Residential institution (1)
Sports and athletic areas (3)

Armory Police station or cell

Assembly hall Post office

Campus Private club

Child center Public building

Church Public hall

Cinema Salvation army

Clubhouse School (grounds) (yard)

College School (private) (public) (state)

Country club (grounds) Theatre

Court house Turkish bath

Dance hall University

Day nursery (day care) YMCA

Drive in theater Youth center

Fire house YWCA

Gallery

Health club

Health resort

Health spa

Hospital (parking lot)

Institute of higher learning

Kindergarten

Library

Mission

Movie house

Museum

Music hall

Night club

Opera house

Playground, school

Police precinct

3. Sports and athletics area

Excludes: Swimming pool or tennis court in private home or garden (0)

Baseball field

Basketball court

Cricket ground

Dude ranch

Fives court

Football field

Golf course

Gymnasium

Hockey field

Ice palace

Racecourse

Riding school

Rifle range - NOS

Skating rink

Sports ground

Sports palace

Squash court

Stadium

Swimming pool (private) (public)

Tennis court

4. Street and highway

Alley

Border crossing

Bridge NOS

Freeway

Interstate

Motorway

Named street/highway/interstate

Pavement

Road (public)

Roadside

Sidewalk NOS

Walkway

5. Trade and service area

Excludes: Garage in private home (0)

Airport

Animal hospital

Bank

Bar

Body shop

Cafe

Car dealership

Casino

Electric company

Filling station

Funeral home

Garage - place of work

Garage away from highway except home

Garage building (for car storage)

Garage NOS

Gas station

Hotel (pool)

Laundry Mat

Loading platform - store

Mall

Market (grocery or other commodity)

Motel

Office (building) (in home)

Parking garage

Radio/television broadcasting station

Restaurant

Salvage lot, named

Service station

Shop, commercial

Shopping center (shopping mall)

Spa

Station (bus) (railway)

Storage Unit

Store

Subway (stairs)

Tourist court

Tourist home

Warehouse

6. Industrial and construction areas

Building under construction

Coal pit

Coal yard

Construction (area, job or site)

Dairy processing plant

Dockyard

Dry dock

Electric tower

Factory (building) (premises)

Foundry

Gas works

Grain elevator

Gravel pit

Highway under construction

Industrial yard

Loading platform - factory

Logging operation area

Lumber yard

Mill pond

Oil field

Oil rig and other offshore installations

Oil well

Plant, industrial

Power-station (coal) (nuclear) (oil)

Produce building

Railroad track or trestle

Railway yard

Sand pit

Sawmill

Sewage disposal plant

Shipyard

Shop

Substation (power)

Subway track

Tannery

Tunnel under construction

Water filtration plant

Wharf

Workshop

7. Farm

Excludes: Farm house and home premises of farm (0)

Barn NOS

Barnyard

Corncrib

Cornfield

Dairy (farm) NOS

Farm buildings

Farm pond or creek

Farmland under cultivation

Field, numbered or specialized

Gravel pit on farm

Orange grove

Orchard

Pasture

Ranch NOS

Range NOS

Silo

State Farm

8. Other specified places

Abandoned gravel pit Military training ground

Abandoned public building or home Mountain

Air force firing range Mountain resort

Balcony Named city

Bar pit or ditch Named lake

Beach NOS (named) (private) Named room

Beach resort Named town

Boy’s camp Nursery NOS

Building NOS Open field

Bus stop Park (amusement) (any) (public)

Camp Parking lot

Camping grounds Parking place

Campsite Pier

Canal Pipeline (oil)

Caravan site NOS Place of business NOS

Cemetery Playground NOS

City dump Pond or pool (natural)

Community jacuzzi Porch

Creek (bank) (embankment) Power line pole

Damsite Prairie

Derelict house Private property

Desert Public place NOS

Ditch Public property

Dock NOS Railway line

Driveway Reservoir (water)

Excavation site Resort NOS

Fairgrounds River

Field NOS Room (any)

Forest Sea

Fort Seashore NOS

Hallway Seashore resort

Harbor Sewer

Hill Specified address

Holiday camp Stream

Irrigation canal or ditch Swamp

Junkyard Trail (bike)

Kitchen Vacation resort

Lake NOS Woods

Lake resort Zoo

Manhole

Marsh

9. Unspecified place

Bathtub

Bed

Camper (trailer)

Commode

Country

Downstairs

Fireplace

Hot tub

Jobsite

Near any place

On job

Outdoors NOS

Parked car

Rural

Sofa

Table

Tree

Vehicle (any)

APPENDIX E - ACTIVITY CODES

The ICD-10 provides a subclassification for use with external causes and injuries to indicate the activity of the injured person at the time the event occurred. This appendix is designed to document the ICD-10 activity code information but it is not entered in manual coding.

Information may be scattered over different parts of the medical certification, Part I, Part II, 41, 43, etc. However, do not use the information in “Injury at work?” block to code this variable.

If no information concerning the activity of the injured person is reported on the certificate, the item is left blank. “While drinking alcohol” or “while driving” is not considered as a codable activity. When two or more codes appear to be appropriate for the information reported, activity code 8 is assigned.

0 While engaged in sports activity

Physical exercise with a described functional element such as:

. golf

. jogging

. riding

. school athletics

. skiing

. swimming

. trekking

. waterskiing

1 While engaged in leisure activity

Hobby activities

Leisure time activities with an entertainment element such as going to the cinema,

to a dance or to a party

Participation in sessions and activities of voluntary organizations

Excludes: sport activities (0)

2 While working for income

Paid work (manual) (professional)

Transportation (time) to and from such activities

Work for salary, bonus and other types of income

3 While engaged in other types of work

Domestic duties such as:

. caring for children and relatives

. cleaning

. cooking

. gardening

. household maintenance

Duties for which one would not normally gain an income

Learning activities, e.g. attending school session or lesson

Undergoing education

4 While resting, sleeping, eating and other vital activities

Personal hygiene

8 While engaged in other specified activities

APPENDIX F - INVALID AND SUBSTITUTE CODES

The following categories are invalid for multiple cause coding in the United States registration areas. Substitute code(s) for use in multiple cause coding appears to the right.

Use the substitute codes when conditions classifiable to the following codes are reported:

Invalid Codes Substitute Codes

A150-A153 A162

A154 A163

A155 A164

A156 A165

A157 A167

A158 A168

A159 A169

A160-A161 A162

B95-B97 Code the disease(s) classified

to other chapters modified by

the organism. Do not enter a

code for the organism.

F70.- F70 (3-characters only)

F71.- F71 (3-characters only)

F72.- F72 (3-characters only)

F73.- F73 (3-characters only)

F78.- F78 (3-characters only)

F79.- F79 (3-characters only)

I151-I158 R99

I23.- I21 or I22

I240 I21 or I22

I252 I258

I65-I66 I63

O08.- O00 - O07

O80.- O95

O81-O84 O759

P95 P969

R69 R95-R99

APPENDIX G - CODES FOR SPECIAL PURPOSES (U00-U99)

Provisional assignment of new codes (U00-U99)

1. Terrorism Classification (U01-U03)

NCHS has developed a set of new codes within the framework of the ICD that will allow the identification of deaths from terrorism reported on death certificates through the National Vital Statistics System. Terrorism-related ICD-10 codes for mortality have been assigned to the “U” category which has been designated by WHO for use by individual countries. The asterisk preceding the alphanumeric code indicates the code was introduced by the United States and is not officially part of the ICD.

To classify a death as terrorist-related, it is necessary for the incident to be designated as such by the Federal Bureau of Investigation (FBI). Neither a medical examiner nor a coroner who would be completing/certifying the death certificate, nor the nosologist coding the death certificate would determine that an incident is an act of terrorism. If an incident or event is confirmed by the FBI as terrorism, it may be so described on the certificate. If the incident is confirmed as terrorism after the death certificate is completed, the certificate can be recoded at a later date.

Not to be used unless notified by NCHS

Tabular List

Assault (homicide)

*U01-*U02

*U01 Terrorism

Includes: assault-related injuries resulting from the unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objectives

*U01.0 Terrorism involving explosion of marine weapons

Depth-charge

Marine mine

Mine NOS, at sea or in harbor

Sea-based artillery shell

Torpedo

Underwater blast

*U01.1 Terrorism involving destruction of aircraft

Includes: aircraft used as a weapon

Aircraft:

• burned

• exploded

• shot down

Crushed by falling aircraft

*U01.2 Terrorism involving other explosives and fragments

Antipersonnel bomb (fragments)

Blast NOS

Explosion (of):

• NOS

• artillery shell

• breech-block

• cannon block

• mortar bomb

• munitions being used in terrorism

• own weapons

Fragments from:

• artillery shell

• bomb

• grenade

• guided missile

• land-mine

• rocket

• shell

• shrapnel

Mine NOS

*U01.3 Terrorism involving fires, conflagration and hot substances

Asphyxia originating from fire caused directly

Burns by fire-producing device or indirectly

Other injury by any conventional weapon

Petrol bomb

Collapse of

Fall from

Falling from burning building or structure

Hit by object

Jump from

Conflagration

Fire

Melting of fittings or furniture

Smoldering

*U01.4 Terrorism involving firearms

Bullet

• carbine

• machine gun

• pistol

• rifle

• rubber (rifle)

Pellets (shotgun)

*U01.5 Terrorism involving nuclear weapons

Blast effects

Exposure to ionizing radiation from nuclear weapon

Fireball effects

Heat

Other direct and secondary effects of nuclear weapons

*U01.6 Terrorism involving biological weapons

Anthrax

Cholera

Smallpox

*U01.7 Terrorism involving chemical weapons

Gases, fumes and chemicals:

• Hydrogen cyanide

• Phosgene

• Sarin

*U01.8 Terrorism, other specified

Lasers

Battle wounds

Drowned in terrorist operations NOS

Piercing or stabbing object injuries

*U01.9 Terrorism, unspecified

*U02 Sequelae of terrorism

Intentional self-harm (suicide)

*U03

*U03 Terrorism

*U03.0 Terrorism involving explosions and fragments

Includes: destruction of aircraft used as a weapon

Aircraft:

• burned

• exploded

• shot down

Antipersonnel bomb (fragments)

Blast NOS

Explosion (of):

• NOS

• artillery shell

• breech-block

• cannon block

• mortar bomb

• munitions being used in terrorism

• own weapons

Fragments from:

• artillery shell

• bomb

• grenade

• guided missile

• land-mine

• rocket

• shell

• shrapnel

Mine NOS

*U03.9 Terrorism by other and unspecified means

SECTION II - External causes of injury

Air

- blast in terrorism U01.2

Asphyxia, asphyxiation

- by

- - chemical in terrorism U01.7

- - fumes in terrorism (chemical weapons) U01.7

- - gas (see also Table of drugs and chemicals)

- - - in terrorism (chemical weapons) U01.7

- from

- - fire (see also Exposure, fire)

- - - in terrorism U01.3

Attack

- terrorist NEC U01.9

Bayonet wound

- in

- - terrorism U01.8

Blast (air) in terrorism U01.2

- from nuclear explosion U01.5

- underwater U01.0

Burn, burned, burning (by) (from) (on)

- chemical (external) (internal)

- - in terrorism (chemical weapons) U01.7

- in terrorism (from fire-producing device) NEC U01.3

- - nuclear explosion U01.5

- - petrol bomb U01.3

Casualty (not due to war) NEC

- terrorism U01.9

Collapse

- building

- - burning (uncontrolled fire)

- - - in terrorism U01.3

- structure

- - burning (uncontrolled fire)

- - - in terrorism U01.3

Crash

- aircraft (powered)

- - in terrorism U01.1

Crushed

- by, in

- - falling

- - - aircraft

- - - - in terrorism U01.1

Cut, cutting (any part of body) (by) (see also Contact, with, by object or machine)

- terrorism U01.8

Drowning

- in

- - terrorism U01.8

Effect(s) (adverse) of

- nuclear explosion or weapon in terrorism (blast) (direct) (fireball) (heat) (radiation)

(secondary) U01.5

Explosion (in) (of) (on) (with secondary fire)

- terrorism U01.2

Exposure to

- fire (with exposure to smoke or fumes or causing burns, or secondary explosion)

- - in, of, on, starting in

- - - terrorism (by fire-producing device) U01.3

- - - - fittings or furniture (burning building) (uncontrolled fire) U01.3

- - - - from nuclear explosion U01.5

Fall, falling

- from, off

- - building

- - - burning (uncontrolled fire)

- - - - in terrorism U01.3

- - structure NEC

- - - burning (uncontrolled fire)

- - - - in terrorism U01.3

Fireball effects from nuclear explosion in terrorism U01.5

Heat (effects of) (excessive)

- from

- - nuclear explosion in terrorism U01.5

Injury, injured NEC

- by, caused by, from

- - terrorism - see Terrorism

- due to

- - terrorism - see Terrorism

Jumped, jumping

- from

- - building (see also Jumped, from, high place)

- - - burning (uncontrolled fire)

- - - - in terrorism U01.3

- - structure (see also Jumped, from, high place)

- - - burning (uncontrolled fire)

- - - - in terrorism U01.3

Poisoning (by) (see also Table of drugs and chemicals)

- in terrorism (chemical weapons) U01.7

Radiation (exposure to)

- in

- - terrorism (from or following nuclear explosion) (direct) (secondary) U01.5

- - - laser(s) U01.8

- laser(s)

- - in terrorism U01.8

Sequelae (of)

- in terrorism U02

Shooting, shot (see also Discharge, by type of firearm)

- in terrorism U01.4

Struck by

- bullet (see also Discharge, by type of firearm)

- - in terrorism U01.4

- missile

- - in terrorism - see Terrorism, missile

- object

- - falling

- - - from, in, on

- - - - building

- - - - - burning (uncontrolled fire)

- - - - - - in terrorism U01.3

Suicide, suicidal (attempted) (by)

- explosive(s) (material)

- - in terrorism U03.0

- in terrorism U03.9

Terrorism (by) (in) (injury) (involving) U01.9

- air blast U01.2

- aircraft burned, destroyed, exploded, shot down U01.1

- - used as a weapon U01.1

- anthrax U01.6

- asphyxia from

- - chemical (weapons) U01.7

- - fire, conflagration (caused by fire-producing device) U01.3

- - - from nuclear explosion U01.5

- - gas or fumes U01.7

- bayonet U01.8

- biological agents (weapons) U01.6

- blast (air) (effects) U01.2

- - from nuclear explosion U01.5

- - underwater U01.0

- bomb (antipersonnel) (mortar) (explosion) (fragments) U01.2

- - petrol U01.3

- bullet(s) (from carbine, machine gun, pistol, rifle, rubber (rifle), shotgun) U01.4

- burn from

- - chemical U01.7

- - fire, conflagration (caused by fire-producing device) U01.3

- - - from nuclear explosion U01.5

- - gas U01.7

- burning aircraft U01.1

- chemical (weapons) U01.7

- cholera U01.6

- conflagration U01.3

- crushed by falling aircraft U01.1

- depth-charge U01.0

- destruction of aircraft U01.1

- disability as sequelae one year or more after injury U02

- drowning U01.8

- effect (direct) (secondary) of nuclear weapon U01.5

- - sequelae U02

- explosion (artillery shell) (breech-block) (cannon block) U01.2

- - aircraft U01.1

- - bomb (antipersonnel) (mortar) U01.2

- - - nuclear (atom) (hydrogen) U01.5

- - depth-charge U01.0

- - grenade U01.2

- - injury by fragments (from) U01.2

- - land-mine U01.2

- - marine weapon(s) U01.0

- - mine (land) U01.2

- - - at sea or in harbor U01.0

- - - marine U01.0

- - missile (explosive) (guided) NEC U01.2

- - munitions (dump) (factory) U01.2

- - nuclear (weapon) U01.5

- - other direct and secondary effects of U01.5

- - own weapons U01.2

- - sea-based artillery shell U01.0

- - torpedo U01.0

- exposure to ionizing radiation from nuclear explosion U01.5

- falling aircraft U01.1

- fire or fire-producing device U01.3

- firearms U01.4

- fireball effects from nuclear explosion U01.5

- fragments from artillery shell, bomb NEC, grenade, guided missile, land-mine, rocket,

shell, shrapnel U01.2

- gas or fumes U01.7

- grenade (explosion) (fragments) U01.2

- guided missile (explosion) (fragments) U01.2

- - nuclear U01.5

- heat from nuclear explosion U01.5

- hot substances U01.3

- hydrogen cyanide U01.7

- land-mine (explosion) (fragments) U01.2

- laser(s) U01.8

- late effect (of) U02

- lewisite U01.7

- lung irritant (chemical) (fumes) (gas) U01.7

- marine mine U01.0

- mine U01.2

- - at sea U01.0

- - in harbor U01.0

- - land (explosion) (fragments) U01.2

- - marine U01.0

- missile (explosion) (fragments) (guided) U01.2

- - marine U01.0

- - nuclear U01.5

- mortar bomb (explosion) (fragments) U01.2

- mustard gas U01.7

- nerve gas U01.7

- nuclear weapons U01.5

- pellets (shotgun) U01.4

- petrol bomb U01.3

- piercing object U01.8

- phosgene U01.7

- poisoning (chemical) (fumes) (gas) U01.7

- radiation, ionizing from nuclear explosion U01.5

- rocket (explosion) (fragments) U01.2

- saber, sabre U01.8

- sarin U01.7

- screening smoke U01.7

- sequelae effect (of) U02

- shell (aircraft) (artillery) (cannon) (land-based) (explosion) (fragments) U01.2

- - sea-based U01.0

- shooting U01.4

- - bullet(s) U01.4

- - pellet(s) (rifle) (shotgun) U01.4

- shrapnel U01.2

- smallpox U01.6

- stabbing object(s) U01.8

- submersion U01.8

- torpedo U01.0

- underwater blast U01.0

- vesicant (chemical) (fumes) (gas) U01.7

- weapon burst U01.2

Date of death 9/11/2001

PLACE I (a) Burns T300

5 (b) Terrorist attack on the Pentagon &U011

MOD II

Homicide

The Pentagon

Date of injury 9/11/2001

Code as terrorism involving destruction of aircraft. The FBI declared the Pentagon incident an act of terrorism.

Date of death 9/11/2001

PLACE I (a) Chest trauma S299

5 (b)

MOD II World Trade Center Disaster &U011

Homicide

World Trade Center

Date of injury 9/11/2001

Code as terrorism involving destruction of aircraft. The FBI declared the World Trade Center incident an act of terrorism.

Date of death 11/1/2017

PLACE I (a) Metastatic lung cancer caused by 9/11 C349

5 (b) First responder at World Trade Center T941 &U02

MOD II

Natural

Code as sequela of terrorism. The FBI declared the 9/11 World Trade Center incident an act of terrorism.

2. Severe Acute Respiratory Syndrome [SARS] (U04)

Tabular List

U04 Severe acute respiratory syndrome [SARS]

U04.9 Severe acute respiratory syndrome [SARS], unspecified

SECTION I - Alphabetical index to diseases and nature of injury

Syndrome

- respiratory

- - severe acute U04.9

- severe acute respiratory syndrome (SARS) U04.9

3. Vaping-related disorder (U07.0)

Tabular List

U07 Codes for emergency use

U07.0 Vaping-related disorder

SECTION I - Alphabetical index to diseases and nature of injury

Damage

- lung

- - dabbing related U07.0

- - electronic cigarette related U07.0

Disorder

- dabbing related U07.0

- electronic cigarette related U07.0

EVALI (e-cigarette or vaping, product use associated lung injury) U07.0

Injury

- lung

- - dabbing related U07.0

- - electronic cigarette related U07.0

4. Coronavirus Disease (COVID-19) 2019 (U07.1)

Tabular List

U07 Codes for emergency use

U07.1 COVID-19

Excludes: Coronavirus infection, unspecified site (B34.2)

Severe acute respiratory syndrome [SARS], unspecified (U04.9)

SECTION I - Alphabetical index to diseases and nature of injury

Coronavirus Disease 2019 U07.1

COVID U07.1

COVID-19 U07.1

Disease

- Coronavirus 2019 U07.1

Infection

- Coronavirus NEC

- - 2019 novel U07.1

- - severe acute respiratory syndrome (SARS) U04.9

- - unspecified site B34.2

- - when referring to COVID-19 U07.1

SARS-CoV-2 U07.1

Severe acute respiratory syndrome coronavirus 2019 U07.1

Severe acute respiratory syndrome coronavirus type 2 U07.1

Sudden acute respiratory syndrome coronavirus type 2 U07.1

2019-nCoV U07.1

2019 novel coronavirus U07.1

Ia) Acute respiratory distress syndrome J80

b) Pneumonia J189

c) COVID U071

Code the COVID to U071.

Ia) Acute hypoxic respiratory failure J960

b) Pneumonia with coronavirus disease 2019 J189 U071

II Chronic Obstructive pulmonary disease J449

Code coronavirus disease 2019 to U071.

5. Post COVID-19 Condition (U09.9)

Tabular List

U09 Post Covid-19 condition

U09.9 Post COVID-19 condition, unspecified

NOTE: This optional code serves to allow establishment of a link with COVID-19.

This code is not to be used in cases that are still presenting COVID-19.

This code is valid for multiple cause coding only.

SECTION I - Alphabetical index to diseases and nature of injury

COVID-19 U07.1

- after effect U09.9

- cleared U09.9

- cured U09.9

- long U09.9

- long COVID syndrome U09.9

- long haul U09.9

- long hauler U09.9

- long-term U09.9

- long-term effects U09.9

- PASC U09.9

- past U09.9

- past COVID syndrome U09.9

- post U09.9

- post-acute U09.9

- post-acute-SARS-CoV-2 U09.9

- post-acute sequela (PASC) U09.9

- post acute syndrome U09.9

- post COVID condition U09.9

- post COVID syndrome U09.9

- previous U09.9

- prior U09.9

- recovered U09.9

- resolved U09.9

Ia) Acute renal failure N179

b) Post COVID U099

Code post COVID to U099.

Ia) Acute hypoxemic respiratory failure J960

b) Hypovolemic shock R571

c) Urinary tract infection N390

d) GI Bleed K922

II Patient recovered from COVID-19 U099

Code recovered from COVID-19 to U099.

APPENDIX H - ADDITIONAL DRUG EXAMPLES

1. Place I (a) Ingested overdose of opiates and ingested alcohol T406 &X42 F109

Code I(a) nature of injury and external cause code for opiate overdose. Code ingested alcohol as indexed. No evidence of alcohol and drug synergism is reported.

2. Place I (a) Ingested overdose of (opiates) and ingested alcohol T406 &X42 F109

Code I(a) nature of injury and external cause code for opiate overdose. Code ingested alcohol as indexed. No evidence of alcohol and drug synergism is reported.

3. Place I (a) Intoxication by the use of cocaine and opiates T405 &X42 T406

Code I(a) nature of injury and external cause code for cocaine and opiate intoxication. Since the drugs are assigned to the same external cause code, code X42. Do not enter a Chapter V code (F codes).

4. Place I (a) Intoxication by the use of (cocaine and opiates) T405 &X42 T406

Code I(a) nature of injury and external cause code for cocaine and opiates intoxication. Since the drugs are assigned to the same external cause code, code X42. Do not enter a Chapter V code (F codes).

5. Place I (a) Toxic effects of cocaine abuse T405 &X42 F141

Interpret I(a) as cocaine poisoning and cocaine abuse. Code nature of injury and external cause code for cocaine poisoning and cocaine abuse as indexed.

6. Place I (a) Toxic effects of illicit drug abuse T509 &X44 F191

Interpret I(a) as drug poisoning and drug abuse. Code nature of injury and external cause code for drug poisoning and drug abuse as indexed.

7. Place I (a) Mixed drug intoxication alcohol and cocaine T519 X45 T405 &X42

Interpret I(a) as poisoning and code nature of injury and external cause code for alcohol and cocaine. Precede the external cause code for the cocaine poisoning with an ampersand.

8. Place I (a) Mixed drug intoxication (alcohol and cocaine) T519 X45 T405 &X42

9 (b)

II Used combination cocaine and alcohol F149 F109

Interpret I(a) as poisoning and code nature of injury and external cause code for alcohol and cocaine. Precede the external cause code for cocaine poisoning with an ampersand. In Part II, code cocaine use as indexed under Dependence, due to, cocaine, and alcohol as indexed under Use, alcohol.

9. Place I (a) Multiple drug intoxication including T509 &X44 T402 T424 T430

9 (b) oxycodone, diazepam, and doxepin

Code the nature of injury code for drug NOS as first entry on I(a). Since the drugs are assigned to different external cause codes, code X44 followed by the nature of injury code for each drug reported.

10. Place I (a) Drug (heroin) intoxication T401 &X42

Code I(a) nature of injury and external cause code for heroin intoxication.

11. Place I (a) Acute multiple drug intoxication (oxycodone T402 &X44 T424

9 (b) and alprazolam)

II Took overdose T509

Code I(a) nature of injury and external cause code for oxycodone and alprazolam intoxication. Since the drugs are assigned to different external cause codes, code X44. Code the nature of injury code for drug NOS in Part II.

12. Place I (a) Acute multiple drug intoxication (ethanol, T510 X45 T402 &X44 T424

9 (b) oxycodone and alprazolam)

Interpret I(a) as alcohol poisoning and drug poisoning. Code the nature of injury and external cause for the alcohol and drugs. Since the drugs are assigned to different external cause codes, code X44 and precede with an ampersand.

13. Place I (a) Acute combined drug intoxication T509 &X44

9 (b) (oxycodone, with diazepam and ethyl T402 X45 T424 T510

MOD II T509 F109

Accident

Took drugs and drank alcoholic beverages

Code the nature of injury for drug NOS as first entry on I(a). Since the drugs are assigned to different external cause codes, code X44. Code the nature of injury for each drug reported on I(b) and the nature of injury and external cause for alcohol. Code the nature of injury for drug NOS and code alcohol as indexed under Drinking, drank (alcohol).

14. Place I (a) Acute intoxication due to ethanol T510

9 (b) abuse, opiate abuse F101 F111

MOD II Drug reaction T509 X44 &X45

Accident

Code I(a) to the nature of injury code for ethanol since this is the first substance reported in the “due to” position. Code I(b) as indexed. Code Part II to drug poisoning since drug NOS is reported and the certifier stated the death was due to an accident. Code the external code for ethanol poisoning as the last code in Part II and precede with an ampersand.

15. Place I (a) Intoxication T402

9 (b) Morphine, Cocaine poisoning T402 &X42 T405

Code I(a) to the nature of injury code for morphine since this is the first substance reported in the “due to” position. Code the nature of injury and external cause code for morphine and cocaine on I(b).

16. Place I (a) Acute intoxication due to the T404

9 (b) combined effects of fentanyl T404 &X42 T406

Code I(a) to the nature of injury code for fentanyl since this is the first substance reported in the due to position. Code the nature of injury and external cause code for fentanyl and opiates on I (b).

17. Place I (a) Cardiac arrhythmia associated with hydroxyzine I499 T435 &X41

9 (b) injection

MOD (c)

A II Hydroxyzine injection T435

Accident

Code first condition on I(a) as indexed. Code hydroxyzine injection as poisoning since it is a psychotropic drug and the certifier reported the death was due to an accident. Code nature of injury for hydroxyzine Part II.

18. I (a) Cardiac arrhythmia associated with hydroxyzine I499

(b) injection

(c)

II Hydroxyzine injection

Code first condition on I(a) as indexed. No code required for the hydroxyzine injection since no complication is reported. It is considered drug therapy since the certifier did not report accident or undetermined in the manner of death block.

19. Place I (a) Acute cardiac arrhythmia precipitated by I499 T405 &X42 T406

9 (b) cocaine and opiates

MOD (c)

A II Drug abuse, cocaine and opiates F141 F111

Accident

Code first condition on I(a) as indexed. Code cocaine and opiates as poisoning since the drugs are narcotics and the certifier reported the death was due to an accident. Code the nature of injury and external cause code for cocaine and opiate poisoning. Since the drugs are assigned to the same external cause code, code X42. Code cocaine abuse and opiates abuse as indexed in Part II.

20. Place I (a) Acute intravenous narcotism (heroin) F112

9 (b)

II Methadone overdose, heroin injection T403 &X42 T401

Code I(a) F112, acute intravenous heroin narcotism. Consider the methadone overdose and heroin injection as poisoning. Heroin is not used for medical care purposes.

21. Place I (a) Acute intravenous narcotism heroin overdose F192 T401 &X42

9 II

MOD

Accident

Interpret I(a) as two separate entities. Code acute intravenous narcotism as first entity and code a nature of injury and an external cause code for heroin overdose as second entity.

22. Place I (a) Acute intravenous narcotism F112

9 (b) Morphine

II Intravenous use of drugs F199

Consider I(b) as continuation of I(a). Code I(a) acute intravenous morphine narcotism and Part II as indexed.

23. I (a) Drug dependence (heroin, cocaine) F112 F142

Code I(a) heroin and cocaine dependence as indexed.

24. Place I (a) Renal failure N19

9 (b) Drug induced hepatotoxicity T509 &X44

Code I(a) as indexed. Code I(b) as poisoning since toxicity (of a site) by a drug is one of the terms that is interpreted as poisoning.

25. Place I (a) Effects of cocaine and methamphetamine use F149 F159

9 (b)

MOD II Drug intake T509 &X44

Accident

Code I(a) as indexed applying intent of certifier instructions for coding use of drugs. Code drug intake as poisoning since drug NOS is reported and the certifier reported the death was due to an accident.

26. Place I (a) Adverse effects of drugs T509 &X44

9 II T509

MOD

Accident

Subject took drugs

Code I(a) to drug poisoning since drug NOS is reported and the certifier stated the death was due to an accident. Code the nature of injury for drug in Part II.

27. I (a) Gastric ulcer K259

(b) Drug intake Y579

Code the gastric ulcer as a complication of the drug reported on I(b). Code the E-code for drug therapy on I(b). It is considered drug therapy since the certifier did not indicate the death was due to an accident or it occurred under undetermined circumstances or the drug was taken in conjunction with alcohol. Code I(c) as indexed and precede with an ampersand.

28. Place I (a) Combined toxicity T509 &X44

9 (b) Heroin and amphetamine T401 T436

MOD II

Accident

Code I(a) to nature of injury for Toxicity, with drugs reported elsewhere on the certificate T509 as indexed. Code external cause to X44 since the drugs are classified to different external cause codes.

29. Place I (a) Poisoning T659 &X44

9 (b) Heroin and amphetamine T401 T436

MOD II

Accident

Code I(a) to nature of injury for Poisoning NOS, T659 as indexed. Code external cause to X44 since the drugs are classified to different external cause codes.

30. Place I (a) Mixed drug poisoning (cocaine, T405 &Y12 T406 T510 Y15

9 (b) opiate, ethanol)

MOD (c)

C II Consumed ethanol with illicit drugs F109 T509

Undetermined

Interpret I(a) as poisoning and code nature of injury and external cause for cocaine, opiate and ethanol. Precede the external cause for the drugs with an ampersand. In Part II, code consumed ethanol as indexed under Consumption, ethanol and code the nature of injury for drug.

31. Place I (a) Subdural hematoma I620

9 (b) Anticoagulation Y442

II Amiodarone lung toxicity T462 &X44

Code I(a) as nontraumatic. Code the E-code for drug therapy on I(b). Code I(c) as indexed and precede with an ampersand to identify the reason for treatment. Code Part II as poisoning since toxicity (of a site) by a drug is one of the terms that is interpreted as poisoning.

32. I (a) Cardiac Arrest I469

(b) Bleeding &R5800

MOD (c) Over coumadinization Y442

Natural

Code I(a) as indexed. Code the bleeding as a complication of the drug reported on I(c). Drug, medicament or biological substance is assumed to be used for medical care unless there are indications to the contrary.

33. Place I (a) Combined opiate and stimulant poisoning T406 &X44 T509

9 (b) Usage of hydrocodone and cocaine F119 F149

MOD II T406 T509

Accident

Used lethal combination of opiates and stimulant drugs

Code I(a) nature of injury and external cause for opiate and stimulant poisoning. Since the drugs are assigned to different external cause codes, code X44. Code I(b) as indexed applying intent of certifier instructions for use of drugs. Refer to Table of drugs and chemicals to find hydrocodone, T402. In Volume 1, the title of category T402 is “Other opioids”. Code hydrocodone use to Addiction, opioids, with fourth character .9, F119. In Part II, code the nature of injury for opiates and stimulant drugs, since “Lethal (amount) (dose) (quantity) of a drug” is interpreted to mean poisoning.

34. Place I (a) Combined analgesic and antihistaminic T398 &X44 T450 T432

9 antidepressant poisoning

MOD (b) Usage of fentanyl promethazine doxylamine F119 F199

A II F199

Accident

Used combination of prescription drugs

Code I(a) nature of injury and external cause for analgesic, antihistaminic and antidepressant poisoning. Since the drugs are assigned to different external cause codes, code X44. Code I(b) and Part II as indexed applying intent of certifier instructions for use of drugs.

35. Place I (a) Combined ethanol and methadone intoxication T510 X45 T403 &X42

9 II Toxic use of drug and ethanol T509 T510

Interpret I(a) as poisoning and code nature of injury and external cause code for ethanol and methadone. Precede the external cause code for the methadone poisoning with an ampersand. Interpret Part II as poisoning and code nature of injury for drug and ethanol.

36. Place I (a) Adverse reaction to drugs and ethanol T509 &Y14 T510 Y15
0

MOD II F109 F139 F119

Undetermined

Used ethanol, citalopram, hydrocodone and metaxalone

Interpret I(a) as poisoning and code nature of injury and external cause code for drugs and ethanol. Precede the external cause code for drug poisoning with an ampersand. In Part II, code use of ethanol and each named drug as indexed. Citalopram and metaxalone use are both assigned to F139. Code only the first mentioned; do not repeat a code on a line.

37. Place I (a) Adverse effects of acetaminophen and alcohol T391 &X40 T519 X45
0

MOD II F199 F109

Accident

Drug and alcohol use

Interpret I(a) as poisoning and code nature of injury and external cause code for acetaminophen and alcohol. Precede the external cause code for acetaminophen poisoning with an ampersand. In Part II, code drug use and alcohol use as indexed.

38. Place I (a) Polypharmacy T509
9

MOD II &X44

Accident

Interpret I(a) as poisoning since the certifier reported the death was due to an accident. Assign the nature of injury for drug on line I(a) since polypharmacy is on the N-only list. Assign the E-code for drug NOS in Part II preceded by an ampersand.

39. Place I (a) Cardiac arrest I469
9 (b) ASCVD I250

MOD II Polypharmacy

Natural

Code condition on I(a) and I(b) as indexed. No code required for the polypharmacy since no complication is reported. It is considered drug therapy since the certifier did not report accident or undetermined in the manner of death block.

40. Place I (a) Acute polypharmacy intoxication (morphine and venlafaxine) T402 &X44 T432
9

MOD II Polypharmacy present T509

Accident

Ingested pharmaceutical substances

Code I(a) nature of injury and external cause code for morphine and venlafaxine intoxication. Since the drugs are assigned to different external cause codes, code X44. Code the nature of injury code for drug NOS in Part II.

41. I (a) Heart failure I509
(b) Cocaine induced cardiomyopathy Y483 &I427

MOD

Natural

Based on instructions for drug-induced, interpret line (b) as drug therapy. There is no indication
of poisoning on this record.

42. Place I (a) Heart failure I509
9 (b) Cocaine induced cardiomyopathy T405 &X42 I427

MOD

Accident

Even though drug-induced is usually an indication of drug therapy, since cocaine is a narcotic and
the manner of death is marked as Accident, interpret as poisoning.

43. Place I (a) Drug-induced cardiac arrhythmia &X44 I499
9 (b)

MOD II Drug-Induced cardiac arrhythmia T509 I499

Accident

Even though drug-induced is usually an indication of drug therapy, since drug nos is reported with
the manner of death marked as Accident, interpret as poisoning.

44. Place I (a) Drug-induced cardiac arrhythmia &X42 I499

9 (b)

MOD II T509 T402 T404

Accident

Consumption of various drugs: codeine, morphine, fentanyl

Even though drug-induced is usually an indication of drug therapy, since narcotics are reported with the manner of death marked as Accident, interpret as poisoning. Assign the E-code for the drug on (a) where the “drug-induced” is reported followed by the condition code. Assign T509 followed by the nature of injuries for the specified drugs reported in the How Injury Occurred block. Do not repeat a code on a line.

45. Place I (a) Drug-induced cardiac arrhythmia &X42 I499

9 (b) (Codeine-free, morphine-free) T402

MOD II Drug-Induced arrhythmia T509 I499

Accident

Even though drug-induced is usually an indication of drug therapy, since narcotics are reported with the manner of death marked as Accident, interpret as poisoning. Assign the E-code for the drug on (a) where the “drug-induced” is reported followed by the condition code. Disregard the terminology “free” on line (b) and assign T402 for both drugs. Do not repeat a code on a line. Assign T509 for the drug mentioned in Part II followed by the code for arrhythmia.

46. Place I (a) Adverse reaction to heroin T401 &X42

9 (b)

MOD II Used heroin F119

Accident

Code Part I as poisoning since heroin is not a drug used in therapy. Additionally, the Manner of Death is marked Accident with a narcotic, both indications of poisoning. Code Part II as indexed.

47. Place I (a) Adverse reaction to fentanyl T404 &X42

9 (b)

MOD II Atherosclerotic cardiovascular disease I250 F119

Accident

Used fentanyl

Code Part I as poisoning since a narcotic is reported with the manner of death marked as Accident. Code Part II and How Injury Occurred as indexed.

48. Place I (a) Toxicity - multiple drugs T509 &X42 T405 T404 T401 T402

9 including cocaine, fentanyl,

heroin and hydrocodone

MOD II T509

Accident

Multiple drug toxicity

Code the nature of injury code for toxicity NOS (with drugs reported elsewhere on the certificate) as first entry on I(a) followed by the e-code for the drugs. Since the drugs are assigned to the same external cause code, code X42. Code the nature of injury for each drug reported, including drug NOS in Part II.

49. Place I (a) Toxicity T659 &X46

9 (b) Intoxication by acetone T524

MOD II

Accident

Since there is no indication of drug on the record, code the nature of injury code for toxicity NOS as first entry on I(a) followed by the e-code for the acetone. Code the nature of injury for the acetone reported on line (b).

50. Place I (a) Poisoning by oxycodone, hydroxyzine, T402 &X44 T435

9 (b) dextromethorphan and butalbital T483 T423

MOD

Accident

Code nature of injury codes for the oxycodone and hydroxyzine reported on line I(a). Since the drugs are assigned to different external cause codes, assign X44. Code the nature of injury codes for the dextromethorphan and butalbital reported on I(b).

51. Place I (a) Combined morphine, citalopram, diphendydramine T402 &X44 T432 T450

9 (b) Alprazolam, bupropion and topiramate intoxication T424 T432 T426

MOD II COPD, HTN, Asthma J449 I10 J459 T509

Accident

Drug related

Code nature of injury codes for the drugs reported on line I(a). Since the drugs are assigned to different external cause codes, assign X44 in the second position on I(a). Code the nature of injury codes for the drugs reported on I(b). Code Part II conditions as indexed. Assign T509 for drug reported in the How Injury Occurred block.

52. Place I (a) Alprazolam and carbon monoxide toxicity T424 &Y11 T58 Y17

9 (b)

MOD II

Could not be determined

Code nature of injury and external cause code for the alprazolam followed by the nature of injury and external cause code for the carbon monoxide. There is no appropriate combination category for drugs and chemicals, so code separately.

53. Place I (a) Positional asphyxia in the setting of mixed drug T71 &W84

9 (b) toxicity (heroin, trazadone, diltiazem) T401 X44 T432 T461

MOD II F191 T71

Accident

Drug abuse / positional asphyxia

Code I(a) as indexed, preceding the W84 with an ampersand since it is the first mentioned E-code. Assign the N and E-codes for the named drug poisoning on line I(b). In Part II, code drug abuse as indexed and repeat the nature of injury code for asphyxia.

54. Place I (a) Mixed drug intoxication, heroin cocaine ethanol T401 &X42 T405 T510 X45

9 (b)

MOD II

Accident

Code I(a) to the nature of injury and external cause codes for the named drugs, preceding the e-code with an ampersand.

55. Place I (a) Mixed drug intoxication: heroin cocaine ethanol T509 &X42 T401 T405 T510 X45

9 (b)

MOD II

Accident

Code I(a) T509 followed by the external cause code for the drug preceded by an ampersand. Assign the nature of injuries for the remaining specified drugs and the nature of injury and external cause code for the ethanol poisoning.

56. Place I (a) Mixed drug intoxication; heroin cocaine ethanol T509 &X42 T401 T405 T510 X45

9 (b)

MOD II

Accident

Code I(a) T509 followed by the external cause code for the drug preceded by an ampersand. Assign the nature of injuries for the specified drugs and the nature of injury and external cause code for the ethanol poisoning.

57. Place I (a) Mixed drug intoxication - heroin cocaine ethanol T509 &X42 T401 T405 T510 X45

9 (b)

MOD II

Accident

58. Place I (a) Mixed drug intoxication / heroin cocaine ethanol T509 &X42 T401 T405 T510 X45

9 (b)

MOD II

Accident

59. Place I (a) Acute combined drug intoxication with T509 &X42 T406 T405 T510 X45

9 (b) opiates, cocaine, and ethanol

MOD II

Accident

60. Place I (a) Multidrug Toxicity T509 &X44

9 (b)

MOD II F119 F149

Accident

Used fentanyl and cocaine

Code I(a) T509 followed by the external cause code for drug NOS preceded by an ampersand. In Part II, code used fentanyl and cocaine as indexed.

APPENDIX I - GUIDANCE IN CERTAIN EXTERNAL CATEGORIES

1. General Guidelines in coding Legal Intervention (Y35)

There are very few guidelines offered in the Classification for addressing Legal Interventions and it can be very difficult to determine when these categories are appropriate. To aid in classifying these types of records, apply the general interpretations below:

General Guidelines

- When alcohol or drug poisoning is reported in addition to a legal intervention event, do not apply the legal intervention concept to the poisoning; code according to the usual guidelines

NOTE: If the Manner of Death is marked Homicide, disregard and code poisoning as Accidental.

- When a police chase results in death to the person(s) being chased, code as a legal intervention death; when a police chase results in death to an innocent bystander, do not apply the legal intervention concept to the bystander

- When a decedent kills themselves and police are mentioned on the record, do not apply the legal intervention concept; code according to the usual guidelines.

- When a ‘suicide by cop’ is reported, code as a legal intervention death according to the circumstances described

I (a) Gunshot wounds to chest S219 &Y350

(b) Massive trauma to internal organs T148

MOD (c)

H II Lethal dose of methamphetamine T436 X41

Homicide

Justifiable homicide by law enforcement

Code as legal intervention involving firearm. Assign the nature of injury and external cause code for accidental poisoning as directed in the legal intervention guidelines.

I (a) Asphyxia due to drowning T751 &Y356

(b) T751

MOD (c)

A II T751

Accident

Drowning in river while fleeing police

Code as legal intervention by other specified means since it seems a police chase resulted in the death of the person being chased.

Place I (a) Contact gunshot wound to chest S219 &X72

9 (b)

MOD (c)

S II T141

Suicide

Shot self with handgun during police standoff

Code as suicidal gunshot wound since the police did not inflict the fatal injury.

2. Restraint

Restraint can be seen reported in conjunction with drug intoxication or a mental health crisis. When reported as a means of limiting another’s physical movement, code restraint only when reported with a resulting injury such as asphyxia, suffocation, etc.

When Is reported on the Code

record with

A threat to breathing

term such as: restraint the asphyxia, strangulation, suffocation

asphyxia T71 followed by the appropriate external

strangulation cause code for the restraint

suffocation

Place I (a) Restraint asphyxia with methamphetamine intoxication T71 &X58 T436 X41

9 (b)

MOD (c)

A II T71 T436

Accident

Asphyxiated after being restrained while intoxicated on methamphetamine

Code T71 for the asphyxia followed by the external cause code for specified accident to represent the restraint. Assign the nature of injury and external cause code for the poisoning. In Part II, assign the nature of injury codes for asphyxia and methamphetamine reported in the how injury occurred block.

I (a) Cardiac arrhythmia during police restraint I499

(b) Heart enlargement from hypertension

MOD (c) Alcohol dependence, cocaine abuse, I517

H (d) and schizophrenia I10

(e) F102 F141 F209

II T149 &Y356

Homicide

Altercation with police

Code I(a) as indexed. Reformat police restraint down to line (b) to accommodate the format term “during”. No code required since there is no resulting injury. Code remaining Part I conditions as indexed. Code Y356 for altercation with police in Part II. Precede with a T149 since no injury is reported.

When Is reported on the Code

record with

T17 plus appropriate fourth character.

aspiration NOS restraint Also, code the appropriate W78, W79,

W80 if not previously coded

e-code for restraint where reported

aspiration of substances

or objects

Place I (a) Aspiration of vomitus during prone restraint T179 W78

1 (b) Methamphetamine intoxication &Y356

MOD (c) T436 X41

H II

Homicide

Arrested and taken to jail. Restrained by law enforcement officers in jail.

Code I(a) as indexed. No ampersand is needed for the aspiration since it is due to another external cause. Reformat restraint down to line (b) to accommodate the format term “during”. Code Y356 for restrained by law enforcement officers. Code drug poisoning on line (c). Assign the nature of injury and external cause code for accidental poisoning as directed in the legal intervention guidelines. Precede Y356 with an ampersand since it is the first mentioned e-code.

Place I (a) Sudden cardiac death while being restrained I461

9 (b) during struggle

MOD (c)

H II Mixed drug intoxication; epilepsy; obesity T509 &X85 G409 E669 R55 R451

Homicide

Collapsed after agitated behavior while being controlled by restraint protocol

Code I(a) as indexed. No code required for restrained since there is no resulting injury. Code Part II conditions as indexed. Code R55 for collapse and R451 for agitated behavior as indexed under Agitation.

________________________

ⁱ Similar terms include modifiers such as many, numerous, recurrent, repeated, serial, series, or several.

Instructions for Classifying the Multiple Causes of Death, ICD-10, 2025

SECTION I - INSTRUCTIONS FOR CLASSIFYING MULTIPLE CAUSES OF DEATH, 2025

SECTION I - INTRODUCTION

A. Introduction

B. Medical Certification

SECTION II - GENERAL INSTRUCTIONS

A. Introduction

1. Excessive Codes

2. Created Codes

3.“Dagger and asterisk” codes

B. General coding concept

1. Definitions and types of diagnostic entities

a. One-term entity

b. Multiple one-term entity

c. Adjectival modifier reported with multiple conditions

2. Parenthetical entries

3. Special diagnostic entities

4. Plural form of disease

5. Implied “disease”

6. Drug dependent, drug dependency

C. Format

1. “Due to” relationships involving more than four causally related conditions

2. Connecting terms

a. “Due to” written in or implied

b. Not indicating a “due to” relationship

3. Condition reported as due to I(a), I(b), or I(c)

4. Numbering of causes reported in Part I

5. Punctuation marks

6. Conditions in the duration box

D. Doubtful diagnosis

1. Doubtful qualifying expression

2. Interpretation of “either…or…”

E. Conditions specified as “healed” or “history of”

F. Coding entries such as “same,” “ ditto ("),” “as above”

G. Conditions qualified by “postmortem,” “rule out,” “ruled out,” “r/o”

H. Nonindexed and illegible entries

1. Terms that are not indexed

2. Illegible entries

I. Coding one-character reject codes

1. Reject code 1-5-Inconsistent duration

2. Reject code 9 - More than four “due to” statements

J. Inclusion of additional information (AI) to mortality source documents

K. Amended certificates

L. Effect of age of decedent on classification

1. NEWBORN OR NEONATAL means less than 28 days of age at the time of death.

2. INFANT or INFANTILE means less than 1 year of age at the time of death

3. CHILD or CHILDHOOD means less than 18 years of age at the time of death

4.Congenital anomalies (Q00-Q99)

a. Less than 28 days:

b. Less than 1 year:

5. Congenital syphilis

6. Age limitation

M. Sex limitations

N. Effect of duration on assignment of codes

1. Qualifying conditions as acute or chronic

2. Subacute

3. Exacerbation

4. Acute and chronic

5. Qualifying conditions as congenital or acquired

6. Two conditions with one duration

7. Conflict in durations

8. Span of dates

9. 99 in duration block

O. Relating and modifying conditions

1. Implied site of disease

a. General instructions for implied site of a disease

b. Relating specific categories

c. Exceptions to relating and modifying instructions

2. Coding conditions classified to injuries as disease conditions

SECTION III - INTENT OF CERTIFIER

1. Other and unspecified gastroenteritis and colitis of unspecified origin (A099)

2. Cavitation lung (A162)

3. Spinal Abscess (A180) Vertebral Abscess (A180)

4. Charcot Arthropathy (A521)

5. General Paresis (A521)

6. Viral Hepatitis (B161, B169, B171-B179)

7. Organisms and Infections NOS (B99)

8. Eaton-Lambert syndrome (C80)

9. Erythremia (C940)

10. Polycythemia (D45)

3. Spinal Abscess (A180)
Vertebral Abscess (A180)

26. Parkinson Disease (G20)
Advanced Parkinson Disease (G2000)
Grave Parkinson Disease (G2000)
Severe Parkinson Disease (G2000)